Indications for surgical therapy:
- Fracture gap width (fracture gap width) ≥2 mm.
- Dislocation (displacement or twisting of bones) >1 mm.
- Long oblique fracture (B1)
- Zone of debris in the middle third (B2)
- Fracture of the proximal third (B3)
- Transscaphoid perilunate dislocation fracture (B4).
Legend for B1-B4 – see below “Classification/classification of scaphoid fracture according to Krimmer following Herbert, taking into account CT findings”.
1st order
- Osteosynthesis – connection of the bone ends by insertion of force carriers such as screws (Herbert screw); in the majority of fractures, esp. those without dislocation, a minimally invasive approach is possible; subsequent immobilization in a forearm cast of the wrist for 4 weeks [first-choice procedure]Note: Surgical treatment should be performed promptly after the accident.
- Technique according to Matti-Russe – infolding of a chip + spongiosaplasty (insertion of bone tissue preferably from the medullary cavity (cancellous bone) to fill bone defects); if necessary, additionally Herbert screw in case of pseudarthrosis (disturbed bone healing with formation of a false joint).
Osteosynthesis is indicated in the following conditions:
- Dislocated fractures
- Unstable fractures
- Luxation fractures
- Fractures with defects
Matti-Russe surgery is indicated for:
- Oblique fractures
- Flapping fractures
- Scaphoid pseudarthrosis