OrthoNet

Volar Approach
Surgical Approaches - Volar (Russe) Approach to Scaphoid

- provides good access to scaphoid
- because the majority of the blood supply is DORSAL, this is a good approach for avoiding further injury to the vascular supply of the scaphoid
- this is the preferred approach for acute distal pole fractures and for the nonunion/malunion with the humpback deformity - from the volar side you can spread open the fracture, reduce the flexion/humpback deformity, and put a bone graft strut which is on the correct side to buttress against further deformity. You cannot do this dorsally!
- can also excise the scaphoid and excise the radial styloid from this incision.

Approach

- supine, armboard; remember to prep iliac crest if you’re going to need graft
- landmark the incision according to the tuberosity of the scaphoid and the FCR tendon.
- make the incision curvilinear along the FCR tendon which crosses the scaphoid tuberosity before inserting onto the second and third metacarpal.
- there is no internervous plane - this is strictly an anatomic dissection; beware radial artery just radial to FCR!!!
- mobilize the radial artery laterally, and incise the flexor retinaculum that ensheathes the FCR - then mobilize it medially. The wrist joint and scaphoid lie just under the undersurface of the FCR sheath.
- incise the sheath and capsule - you’ll be right on the tuberosity of the scaphoid.
- to get better exposure of the scaphoid (particularly of the proximal pole), you have to fairly vigorously extend the wrist.