Correct Answer: ORIF through a dorsal approach

This scaphoid is fractured through the proximal pole. This portion of the scaphoid has a poor vascular supply and requires surgery. The dorsal approach is most appropriate to access the proximal half of the scaphoid. Percutaneous procedures have a higher risk of unrecognized screw penetration of subchondral bone. The volar approach (interval between the FCR and radial artery)is best for scaphoid waist and distal pole fractures.

• Source:  2016 AAOS OITE 

• Rettig ME, Kozin SH, Cooney WP. Open reduction and internal fixation of acute displaced scaphoid waist fractures. J Hand Surg Am. 2001 Mar;26(2):271-6. PubMed PMID: 11279573. 
• Raskin KB, Parisi D, Baker J, Rettig ME. Dorsal open repair of proximal pole scaphoid fractures. Hand Clin. 2001 Nov;17(4):601-10, ix. PubMed PMID: 11775471. 
•  Buijze GA, Bachoura A, Mahmood B, Wolfe SW, Osterman AL, Jupiter JB: Reevaluation of the scaphoid fracture: What is the current best evidence? Instr Course Lect2020;69:317-330.
  1. Recommended Readings
• Large TM, Adams MR, Loeffler BJ, Gardner MJ: Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg 2019;27(21):794-805. Full Text
• Waitayawinyu T, McCallister WV, Nemechek NM, Trumble TE: Scaphoid nonunion. J Am Acad Orthop Surg 2007;15(5):308-320. Full Text
• Recommended Video

Cohen MS: Dorsal midline approach to the distal radius and carpus, in Cohen MS, Kalainov DM, eds: Selective Exposures in Orthopaedic Surgery: The Wrist [DVD]. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009. View