Surgery

Last Friday had the opportunity to observe a surgical procedure to fix a non-union scaphoid fracture. This is the first upper extremity surgical procedure I've been able to observe and it was awesome! The surgeon was very good about explaining what he was doing step by step and his assistants made sure that I was in a good position to see all the action. For most of the surgery I was standing on a step stool right behind the surgeon with a birds eye view of the procedure.

Here's the educational part of the blog for those who have been scratching their head at the words "non-union" and "scaphoid". The Scaphoid bone is a carpal bone. Their are eight carpal bones in the wrist. The scaphoid bone articulates with the distal end of the radius bone and the Trapezium bone. For this non medical personnel the radius is the forearm bone on the same side as the thumb. For a visual see the photo below.


The scaphoid bone is most often injured when someone falls and uses their hand, wrist, and arm to brace their fall. This mechanism is often referred to as a FOOSH injury, or falling on an outstretched hand. The scaphoid bone when fractured is notoriously known as a fracture that rarely heals on its own. The reason for this is that the blood supply to this particular bone is not very good and depending on the location of the fracture can cut off the blood supply to one part of the bone completely. With this lack of blood supply the fracture does not heal and is termed as a "non-union" fracture. If the fracture is not treated initially the piece of bone with poor blood supply will gradually begin to die/become necrotic.

The surgical procedure requires an opening incision on the palmar aspect of the wrist and hand to expose the scaphoid bone. The pronator quadratus muscle is detached from its insertion to expose the radius. In this particular case the surgeon had to scrap the dead bone tissue off to get to suitable bone surface for the best possibility of the bone graft to promote healing. Now for the fun part, the harvesting of the bone graft material. The surgeon drilled some small holes on an area of the exposed radius and then bust out the chisel and mallet. He took of a diamond sized section of bone and then scooped out the bone marrow for the bone graft before replacing the diamond bone back where it came from. He then placed the bone graft into place and placed a screw into the scaphoid bone to bring both pieces together.

Often times scaphoid fractures do not show up on x-rays till sometimes three weeks after the initially injury.
Before Surgery:


After Surgery: