Surgical Approaches – Dorsal Approach to Scaphoid
– provides good exposure of the scaphoid, particularly proximally, but endangers the superficial branch of the radial nerve and the dorsal blood supply of the scaphoid.
– can get good access to the proximal pole, and to the radial styloid for excision
– supine, arm board; prep the crest or olecranon for graft
– landmark the anatomic snuffbox, bordered radially by APL and EPB and ulnarly by EPL. If you ulnar deviate the wrist, you can feel the scaphoid slide out from under the radial styloid and become prominent in the snuffbox.
– make the incision gently curved through the snuffbox
– the dissection is anatomic – there is no internervous plane. Basically, you want to go through the snuffbox, between EPB and EPL.
– superficially, there are branches of the superficial radial nerve – watch out for these and try to protect them.
– pull on the thumb to ensure that you know which tendons are which
– incise the fascia between the two tendons and retract EPL ulnarly, EPB radially
– watch out for the radial artery and its dorsal carpal branch just beneath the fascia. The radial artery is crossing through the snuffbox to dip though the first interspace into the volar aspect of the hand.
– incise the capsule longitudinally and retract it ulnarly/dorsally and radially/volarly; the radial artery gets mobilized radially/volarly
– again – don’t fuck up the dorsal carpal branch – this provides the main supply to the scaphoid!