What is a Scaphoid Dislocation?
Such damage is rare. The displacement of the scaphoid occurs in the radial and palmar-radial sides (rotational dislocation).
Symptoms of Dislocation of the Scaphoid
With a dislocation, a diffuse swelling is determined in the area of the wrist joint and especially the anatomical snuff box. The brush occupies a characteristic position: it is deflected to the radial side, and the I finger is in a small abduction position as a result of the tension of the long extensor, under which the dislocated bone is palpated. There is a significant restriction of movement.
Diagnosis of the Dislocation of the Scaphoid
Accurate diagnosis is based on x-ray of the wrist joint in 3 projections.
Scaphoid Dislocation Treatment
Reduction of a fresh dislocation is performed under anesthesia or conduction anesthesia of the brachial plexus area. The hand is bent at an angle of 90 °, the forearm is given the position of pronation. The assistant carries out an anti-pull over a shoulder. The surgeon extends the wrist joint for the II-IV fingers and maximum ulnar deviation of the hand and palmar flexion.
By pressure on the palpable bone in the area of the anatomical snuffbox, the dislocation is corrected while the brush is in the correct position. It should be remembered that the correct position of the adjusted scaphoid can be checked by x-ray, especially in strictly lateral projection: the longitudinal axis of the scaphoid with the axis of the radius forms an angle of 45 °. The joint is fixed with a plaster cast for 3-4 weeks. Disability is restored after 1-1.5 months after reduction.
With chronic dislocation of the scaphoid, closed reduction is not possible, in these cases surgical treatment is indicated. Access to the scaphoid is through an arcuate incision in the projection of this bone. After dissection of the capsule of the wrist joint and approach to the scaphoid bone, it is reduced with minimal trauma to the tissues. In most cases, with such injuries, a complete violation of the blood supply of the scaphoid occurs, which leads to the development of aseptic necrosis, and subsequently deforming arthrosis of the wrist joint.
To restore blood supply to the scaphoid, a vascular bundle is implanted in it, including the dorsal carpal branch of the radial artery with accompanying veins and surrounding perivascular tissues. Previously, a channel with a diameter of 3.2-3.6 mm is drilled along the axis of the bone. Vascular bundle implantation is performed using a spoke, the sharp end of which is brought out from the elbow side. A thin catgut thread is inserted into the conductor’s ear, the second end of which is tied to the distal end of the vascular bundle.
When removing the knitting needle, the catgut thread is brought to the elbow side and a vascular bundle is implanted into the scaphoid canal by pulling the thread. The end of the thread is stitched for the skin and tied on a gauze ball. The wound is sutured in layers. For 4 weeks, a back gypsum splint is applied with fixation of the I finger to the distal joint.