Scaphoid Osteosynthesis

Osteosynthesis is the connection of fragments of bones. The goal of osteosynthesis is the stable fixation of fragments( bone) in the desired position before their consolidation. This operation of the scaphoid bone with spokes or compression screw is necessary for fractures of the scaphoid bone with distance, otherwise diastase between fragments is more than 1 mm, with open fractures of the scaphoid bone, with closed vertically fractured bone fractures and delayed consolidation. The use of metal structures with pseudoarthrosis does not give the desired effect, therefore, bone plastic is produced in such cases. Contraindications, as a rule, to the operation of the standard: this is a serious condition of the patient, general and local infectious entrances.

How osteosynthesis is performed - operation on scaphoid bone

The presence of a distinct fracture, especially with a displacement of fragments, is an indication for the osteosynthesis of fragments by a screw.

Intraosseous anesthesia is mandatory. A longitudinal section of the skin is made, as well as a fascia length of four centimeters in the zone of the "anatomical snuffbox", between the tendon of the short and long extensors of the big finger penetrate to the bone. Dissect the capsule of the joint so as not to damage the branches of the radial artery and radial nerve. Then the wrist joint is opened, the scaphoid tubercle is exposed and the soft tissues are separated from the back surface in such a way that both fragments and a line of fracture are noticeable. Through the thickness of one, then another bone fragments, a thin drill of 1-1.5 mm is applied through the thickness of one, and then the screw is screwed into it to fix firmly the bone fragments, to squeeze them with wound surfaces.

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After that, the skin is stitched. The hand before the removal of the joints is fixed with two longiets, and after that the plaster bandage, the same, is used which, with the usual conservative treatment of fractures, for a month and a half. After the X-ray control study showing the presence of consolidation, as a rule, immobilization is discontinued.

For accurate insertion of the fixator and to reduce the traumatization of tissues, there is a technique of bone osteosynthesis with a screw on the guide spoke. To do this, use a screw with a screw cut, as well as an internal channel, a drill and a screwdriver with a channel for the spoke. Intraosseous anesthesia is performed. A cut is made of the skin, subcutaneous tissue. Only the outer part of the scaphoid bone is exposed, and through it a 2 mm diameter needle is inserted into the other fragment. After the X-ray, specialists are convinced of the correct position of the spoke, and if necessary, make appropriate adjustments. Then the channel is reamed out, the screw is placed on the spoke and it is screwed from the peripheral fragment into the central fragment. After that, they create a mutual interaction between the fragments and secure their fixation. Treatment postoperative is carried out exactly the same as with an open method of osteosynthesis with a screw.

After the application of a bandage, experts recommend that the patient should perform the movements in the joints of all the fingers of the hand, and after removal, as a rule, they are prescribed rehabilitation: medical gymnastics, physiotherapy procedures and massage. Restoration of the ability to work basically comes in a period of 2 to 4 months with a favorable course of adhesion of bone fragments.

False joints of the scaphoid bone develop mainly with untimely diagnosis, as well as with improper treatment.

In cases where it is possible to fix firmly fragments of bone, bone osteosynthesis is used( the procedure is the same as for a fracture).In this case, it is harmful before osteosynthesis to separate the fragments, to excise the scar tissue that connects them;Also, there is no need to use different types and methods of bone plasty. The aim of the operation is, as a rule, to secure the fixation of fragments, to apply the least injury.