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THIRTEEN

Scaphoid Fractures

• Can be performed antegrade (i.e. from

proximal to distal) or retrograde.

• The antegrade technique is used for

proximal pole fractures.

• The retrograde technique is used for

waist or more distal fractures.

• Can be carried out as day case surgery

under regional or general anaesthesia.

• A guide wire is passed across the

fracture under X-ray guidance, along

the central axis of the bone.

• A headless screw is then passed over

the guide wire and buried within the

bone.

• The screw has a differential pitch,

meaning that when inserted it leads to

compression at the site of the fracture,

optimising the chance of healing.

• It is unusual to need the screw to be

removed in the medium to long-term.

Percutaneous screw fixation of

the scaphoid – technical aspects

Mr Gidwani has been a Consultant

Orthopaedic Hand Surgeon at

Guy’s and St Thomas’ Hospital

since 2009 and Lead Clinician of

the Department of Orthopaedics

since October 2014. He qualified

at King’s College London in 1995,

completed his orthopaedic training

in SouthWest London and carried

out his fellowship training at

recognised hand surgery centres

in Oxford, Derby and Brisbane.

He has also been awarded the

British Postgraduate Diploma in

Hand Surgery.

Mr Gidwani runs a regular

specialist hand and wrist clinic

at St Thomas’ Hospital, receiving

secondary and tertiary referrals

from across the South East. He

provides theWrist Trauma and

Reconstructive Service to the

Orthopaedic Department and also

contributes to the Regional Plastics

Hand Trauma Service based at

St Thomas’ Hospital.

He treats amateur and professional

sportsmen and women and was a

member of the team of surgeons

dealing with athletes’ hand and

wrist injuries during the 2012

London Olympics. His special

interests include osteoarthritis and

rheumatoid arthritis, Dupuytren’s

disease, nerve compression

syndromes, tendon transfer surgery

and wrist and hand trauma.

www.londonhandsurgeon.co.uk www.workinghandscharity.org

CASE STUDY

MR SAM GIDWANI

CONSULTANT

ORTHOPAEDIC

HAND SURGEON

Name: Mr A. F.

Age: 22

Procedure:

Percutaneous xation

A 22-year-old Masters student was pushed over

during a game of ve-a-side football and landed on his

outstretched dominant left hand. His wrist gradually became more

painful over the evening, so the following day he saw his GP who

suspected he may have a scaphoid fracture. Radiographs were

carried out which con rmed the diagnosis of an un-displaced

scaphoid waist fracture, and he was referred to Mr Gidwani.

After a discussion of the pros and cons of cast treatment versus

percutaneous xation, the patient elected to be treated in a cast. He

returned to the clinic within a week, however, having changed his mind

– he was frustrated by the cast, and by the dif culties he experienced

while trying to write and take notes during lectures.

A few days later, a percutaneous xation was carried out. He was kept

in a cast for two weeks, before being transferred into a removable splint.

A CT scan carried out at 12 weeks post-operatively con rmed complete

union of the fracture and at that stage, all restrictions were lifted on use

of the wrist for sports and leisure activities.

At four months post-op, he has recovered a full range of motion

( gures

4 and 5)

, is back to skiing and playing football, and hopes to be back

on the basketball court soon.

Figure 3

Figure 1

Figure 4

Figure 5

Figure 2

Figure 1:

An un-

displaced fracture

of the scaphoid waist

Figure 2:

Fracture healed

after percutaneous

screw fixation

Figure 3:

The

typical scar left after

percutaneous fixation

Figures 4 & 5:

Excellent recovery

of range of motion

Scaphoid Fractures

For more information on Hand and Wrist Services, please contact the GP Liaison Department on:

T: 020 7234 2009

Mr Sam Gidwani

Consultant Orthopaedic

Hand Surgeon