Three-dimensional comparison of alternative screw positions versus actual fixation of scaphoid fractures

Deviations in positioning variable pitch screws- scaphoid waist fractures

INTRODUCTION

Operative therapy using a headless cannulated variable pitch compression screw is the gold standard for the treatment of instable scaphoid fractures.

HYPOTHESIS

Deviation from the central placement is associated with a loss of stability and stiffness.

MATERIAL AND METHODS

An artificial bone model was manufactured and different screw positions (central, 10° and 20° to the long axis) were assessed. A shearing test with axial force on the 45° flexed scaphoid was applied.

RESULTS

The inserted variable pitch screw showed the highest stiffness and failure force in a position in the long axis. At 10 degrees, a slight decrease in stiffness (32.7N/mm±9.3N/mm) and failure force (41.6N±13.2N) was observed, while a significant reduction in stiffness (29.3N/mm±4.6N/mm) and failure force (50.3N±19.5N) was measured at 20 degrees.

DISCUSSION

Deviations in the angle of insertion of the compression screw cause loss in failure force, thus deviations from the central placement is associated with less stability and stiffness.

LEVEL OF PROOF

Controlled laboratory study (basic science study, biomechanical testing).