Scaphoid – Volar Approach

Modern Study Review (AI-Generated)

High-Yield Summary

The Volar (Russe) Approach to the scaphoid is the gold standard for acute distal pole fractures and scaphoid nonunions with humpback deformity. It offers direct volar access for fracture reduction, bone grafting, and deformity correction while preserving the predominantly dorsal blood supply. Although lacking a true internervous plane, careful dissection around the radial artery and flexor carpi radialis (FCR) tendon ensures safe exposure. This approach remains essential for open reconstruction despite increasing use of arthroscopic techniques.

Applied Anatomy & Intervals

Internervous Interval

• None; this is a direct anatomic dissection without a true internervous plane.

Anatomic Landmarks

• Tuberosity of the scaphoid (palpable volarly)
• Flexor Carpi Radialis (FCR) tendon (runs over the scaphoid tuberosity)
• Radial artery (immediately radial to the FCR tendon)

Patient Positioning & Setup

• Table Type: Standard operating table with armboard
• Patient Position: Supine with the arm abducted on an armboard
• Specialized Equipment:
• Optional upper arm tourniquet
• Wrist extension support or manual extension by assistant to improve proximal pole exposure
• Iliac crest prep if autograft anticipated

Surgical Technique (The “Vital Steps”)

Incision & Superficial Dissection

• Make a curvilinear incision along the FCR tendon, centered over the scaphoid tuberosity.
• Identify and protect the radial artery, which lies immediately radial to the FCR tendon; mobilize it laterally.
• Incise the flexor retinaculum sheath of the FCR and retract the tendon medially.

Deep Dissection & Exposure

• Incise the FCR sheath and the volar wrist capsule directly over the scaphoid tuberosity.
• Extend the wrist to improve visualization of the proximal pole.
• Expose the scaphoid for fracture reduction, bone grafting, or excision as indicated.

The “Danger Zone”

Post-Operative Pearl

Early wrist mobilization is generally delayed to protect graft incorporation and fracture healing. Gentle finger motion should begin immediately to prevent stiffness. Avoid wrist extension beyond neutral initially to protect the repair and graft.

Classic Clinical Notes

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.

Last Updated on January 25, 2026 by orthonet