I was able to carry out an arthroscopic exploration of a pseudarthrosis of the scaphoid followed by an osteosynthesis still under arthroscopy. The one-month internship, which I spent at the hand institute in Paris (Clinique Jouvenet) was of great help to me. In particular, wrist arthroscopy impressed me a lot, especially when performed by Prof. Mathoulin.
On 04/01/2014, I performed an osteosynthesis of a pseudarthrosis of the right scaphoid dear a young man aged 22 who had a wrist trauma dating back approximately 4 months. Under locoregional anesthesia, antibiotic prophylaxis, tourniquet at the root of the operated limb, traction and counter-traction on the limb (2-3 fingers).
I started with the exploration of the radio-carpal by way 3-4, visualizing: the triangular ligament, the scapholunate and scapho-radial spaces, leaving way 1-2 for irrigation by needle connected to the serum physiological. This exploration does not reveal any lesion.
The exploration of the mediocarpal was carried out by the radio metacarpal way for scope and the ulno metacarpal way for instruments. The scapholunate ligament is inspected first (intact), followed by the focus of the pseudarthrosis.
After mobilization of the distal pole and regularization of the edges of the pseudarthrosis site, the reduction could be carried out using a blunt pin. Reduction stabilized by double retrograde pinning under control of the image intensifier and the arthroscope. Pins introduced via a short approach opposite the distal end of the scaphoid. After checking the range of motion of the wrist, hydrophilic dressing with anterior analgesic splint, change of dressing on the 3rd day with immobilization by resin handle with apposition of the thumb and ulnar inclination, allowing complete flexion of the fingers. The postoperative follow-up is simple with removal of the resin sleeve on the 45th day, followed by rehabilitation with recovery of amplitudes and strength.
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