Percutaneous Cannulated Screw Fixation

Yeah, so, I have surgery on Tuesday to insert a titanium screw into my broken wrist.

More geeky details below.

(I just remembered that Stephen Colbert broke his wrist --- chipped his triquetrum --- last year... remember, he started his "Wrist Watch" campaign and began wearing his WristSTRONG bracelets.)

The decision to do surgery was a hard one to make... it took a ton of research and benefited from two parents that are physicians (one who did surgery rotations in residency). To recap, I broke the scaphoid bone in my wrist earlier this week. The break is clean and not displaced (read: there's no gap between the two halves of the broken bone); this means it could heal on its own with only a cast. Unfortunately, due to the blood flow going to that bone (only one side of the bone is supplied with blood), the bone heals slowly and I'd have to wear the cast for 12 weeks. Even then, it could get worse and still require surgery. Part of the decision to go with surgery had to do with the invasiveness of the procedure...

The procedure that my hand surgeon recommends is called percutaneous cannulated screw fixation, PCSF (of the left scaphoid). Using this procedure, my bone should be fully healed by September 2 (95% of grip strength should be back by November). This involves a small incision in the wrist and a guide wire is inserted to the base of the bone. A drill is used to drill a cannulated screw through the scaphoid (See Fig. 1 of Toby et al. 1997). When screwed into place, the screw creates compression forces that keep the sides of the bone in contact. This contact allows the blood vessels to regrow across the fracture and the for the bone to fill the fracture.

This is vastly superior to the old-school technique of "open reduction"... where the flesh of the skin is flayed to get access to the bone. Yikes.

The screw will remain in me for life... and will probably set off metal detectors. The bone grows over the end of the screw.

(Michelle's flying out to be with me next week, yay!)

Image from HaddaD and Goddard, 1998.

References

• Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. Journal of Bone & Joint Surgery. 1998;80-B(1). Available at: [Accessed July 12, 2008].
• Toby EB, Butler TE, McCormack TJ, Jayaraman G. A Comparison of Fixation Screws for the Scaphoid during Application of Cyclical Bending Loads. Journal of Bone and Joint Surgery. 1997;79(8):1190-7. Available at: [Accessed July 12, 2008].