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OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Right scaphoid proximal pole fracture POSTOPERATIVE DIAGNOSIS: Right scaphoid proximal pole fracture SURGEON: Raymond Redman, MD OPERATIONS: Open reduction internal fixation, night scaphoid fracture ANESTHESIA: General OPERATIVE INDICATIONS: This patient is a 15-year-old who injured his right wrist at a school wrestling meet. He was seen in the clinic and found to have a fracture involving the right scaphoid. The fracture involved the proximal pole. It appeared to be relatively transverse in orientation. Due to the proximal nature of the injury and concern for potential healing, he is now brought for open reduction internal fixation OPERATIVE FINDINGS: The fracture was non displaced. It was stabilized using a Synthes 3-0 cannulated screw with a threaded washer. OPERATIVE PROCEDURE: After adequate induction of general anesthetic, the right wrist was prepped and draped in a standard fashion. Because of the proximal nature of the fracture, a dorsal approach was chosen. A longitudinal skin incision was made over the dorsal aspect of the wrist, centered over the scaphoid. It was carried down sharply through Subcuticular tissues. The extensor retinaculum was identified and incised. The wrist was then entered between the third and fourth dorsal compartments. The scaphoid was readily viable and access could be gained to the proximal pole with dorsiflexion of the wrist. The fracture appeared to be nondisplaced. There was no need for bone grafting. Therefore, a Synthes 1.1-mm K wire was passed from the proximal pole across the fracture into the distal pole. Several passes were made before the nosition was then aantahan matalval was achieved.SS.Snic.amidance wized Print Activity @ https://com OPERATIVE PROCEDURE: After adequate induction of general anesthetic, the right wrist was prepped and draped in a standard fashion. Because of the proximal nature of the fracture, a dorsal approach was chosen. A longitudinal skin incision was made over the dorsal aspect of the wrist, centered over the scaphoid. It was carried down sharply through subcuticular tissues. The extensor retinaculum was identified and incised. The wrist was then entered between the third and fourth dorsal compartments. The scaphoid was readily viable and access could be gained to the proximal pole with dorsiflexion of the wrist. The fracture appeared to be nondisplaced. There was no need for bone grafting. Therefore, a Synthes 1.1-mm K-wire was passed from the proximal pole across the fracture into the distal pole. Several passes were made before the position was thought to be acceptable, but ultimately it was achieved. Fluoroscopic guidance was utilized in placement of the guidewire. After this was done, the cannulated countersink was utilized to a depth of 7.5 mm. There was some concern about over countersinking, which could possibly reach the level of the fracture. A threaded washer was then seated fully. After this was done, a depth gauge was utilized and a 22-mm 3.0 cannulated screw was then placed and seated fully into the threaded washer. Excellent compression was obtained. The screw and the fracture were visualized on fluoroscopy, but also on plain films, and the fracture was found to be anatomic. The screw was within the scaphoid throughout. Although the screw head was countersunk and recessed into the threaded washer, it was rather close to the articular surface, which raised the possibility of future screw removal. The wrist was then placed through a full range of motion without the screw head contacting the articular surface. After this was done, the wound was irrigated. The wrist was closed using 3-0 Vicryl in figure of eight fashion. The extensor retinaculum was then closed using a combination of 2.0 Vicryl in figure of eight fashion and 2-0 Ethibond. The Ethibond suture was left as a marker in case the future screw removal should be necessary. The wound was again irrigated and then the skin was closed using 5.0 nylon in horizontal mattress fashion. A dressing of Xeroform, plain gauze, Webril, a thumb spica splint, and an ACE wrap was applied. The tourniquet was released after 84 minutes and the vascular status of the right upper extremity returned to normal. The patient tolerated the procedure well and was returned to the recovery room in stable condition 1. CPT Code: 2. ICD-10-CM Codes:
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