Minimally Invasive Arthroscopic-Assisted Treatment for Isolated Scaphoid Fossa Die Punch Nascent Malunion.

Abstract

A die punch fracture is an intra-articular fracture of the distal radius characterized by a localized depression of the articular surface, typically occurring in the lunate fossa. Misdiagnosis or incorrect management can lead to articular malunion. While die punch fractures in the scaphoid fossa are less common, their nascent malunions pose significant treatment challenges. Traditionally, these fractures are treated with an open dorsal and volar approach, combined with osteotomy and internal fixation. Arthroscopic-assisted osteotomy has emerged as a promising technique due to its precision and minimally invasive nature. We present a new arthroscopic assisted minimally invasive technique for treating isolated dislocated die punch fracture nascent malunion of the scaphoid fossa. We treated an isolated scaphoid die punch nascent malunion, with a 5 mm joint surface depression. Using a 3-4 portal and a 30-degree curved mini osteotome, we performed an intra-articular osteotomy of the fragment. A small 2 cm skin incision over the Lister tubercle and a 1 cm bone window facilitated the introduction of a 30-degree curved curette to elevate and anatomically reduce the fragment under arthroscopic guidance. Definitive fixation was achieved with 3 K-wires. Postoperative x-rays at 6 weeks show complete fracture consolidation, confirmed by a subsequent computed tomography scan. At 3 months, patients demonstrated satisfactory clinical recovery with wrist range of motion and grip strength equal to the contralateral wrist, returning to normal activities. This technique is feasible and safe, minimizing soft tissue damage, preserving proprioception and vascularity, and enabling faster recovery.