Terry L. Whipple, M.D.

Union in acute scaphoid fractures is problematic. It is impossible to determine whether the fracture will heal rapidly, and cast immobilization with conservative care can range from 8 to 30 weeks. Dr. Whipple's first preference is to treat these fractures surgically, even when uncomplicated, because of the advantages: less morbidity, less cost than may be incurred with long-term casting, and earlier return to function (1-4 weeks). A major disadvantage of internal fixation, however, has been its technical difficulty. Dr. Whipple's work with the Herbert/Whipple screw has been toward developing ways to make the procedure easier and more predictable.

In this segment, Dr. Whipple presents the operative approach in the overall context of acute scaphoid fracture management. He discusses the indications for surgical fixation, the two common surgical approaches, and available fixation devices. He demonstrates his open arthrotomy, arthroscopically assisted, and retrograde investment (proximal pole fracture) techniques for fixation using the screw. He closes with pointers on postoperative regimen and avoidance of operative pitfalls.

While of general interest, this segment will be especially interesting to hand surgery specialists because of Dr. Whipple's recommendation of an earlier surgical approach, cost containment, and his emphasis on surgical effectiveness and outcome enhancement.

References
1. Herndon JH, ed Scaphoid fractures and complications Rosemont, IL: American Academy of Orthopedic Surgeons 1993
2. Whipple TL Arthroscopic Surgery: The Wrist Philadelphia, PA: Lippincott 1992
3. Gelberman FH, Menon J The vascularity of the scaphoid bone J Hand Surg 1980;5A:508-513

• Total Run Time: 29:38 minutes
• Catalog Number: 3007
• Publication Date: February 1995

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