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.
– 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.