Eric Wagner, MD, FAAOS | Keir M Blevins, MD | Anna Gorsky, BS | Nicole Greene, BA | Krishna Chopra, MA

Standard wrist arthroscopy portals were established, with the 3-4 portal for visualization and the 6R as the working portal. An extensive synovectomy was undertaken and viewing changed to the 6R portal to visualize the fracture site along the proximal pole. The 3-4 portal was used to debride the fracture site and to allow full visualization of the scaphoid proximal pole for accurate screw placement. Midcarpal portals were established with the MCU for viewing and MCR as the working portal for complete debridement of the fracture.

The wrist was flexed in the arthroscopy tower and fluoroscopy confirmed adequate reduction of the scaphoid. Two K wires were placed percutaneously across the scaphoid fracture utilizing both fluoroscopy and arthroscopic viewing of the proximal pole through the 3-4 portal to assess screw start sites. Two in-frame 2.0 screws were placed across the fracture percutaneously along the path of each K wire. Both fluoroscopy and arthroscopy confirmed final screw placement and final screw depth below the scaphoid cartilage. Distal radius autologous bone graft was harvested proximal to Lister’s tubercle and delivered into the nonunion site through the MCR portal following fixation of the fracture.