Monday 18 June 2012

scaphoid nonunion

35 year old rt handed office assistant fell down 3 months back. He was advised surgery by the attending orthopod but refused.  returned 3 months later with the following xray







It was planned for a percutaneous grafting and herbert screw as described the late Dr. Slade. Unfortunately the graft introducer was bigger than the proximal drill hole. The plan was to put the percutaneous wire proximal to distal Drill(red line) the proximal fragment with a larger drill (green line)to put a custom currette thru the hole and currette the cyst and bone graft the cyst with  cancellous grafts thru the custom graft introducer similar to a bone marrow aspiration needle and compress the the fracure with a herbert screw. Finally only percutaneous compression with a herbert screw was done and at 4 weeks the fracture appears to be joining.   Ideally the deformity should be corrected and graft should be used. Luckily this is uniting


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