1
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Mickley JP, Lynch DJ, Gordon AM, Roebke AJ, Goyal KS. Fracture Gap Closure and Reduction Are Affected by the Orientation of the Headless Compression Screw. Hand (N Y) 2024; 19:656-663. [PMID: 36692082 PMCID: PMC11141410 DOI: 10.1177/15589447221150504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND We evaluated the impact of a variable-pitch headless screw's angle of insertion relative to the fracture plane on fracture gap closure and reduction. METHODS Variable-pitch, fully threaded headless screws were inserted into polyurethane blocks of "normal" bone model density using a custom jig. Separate trials were completed with a 28-mm screw placed perpendicular and oblique/longitudinal to varying fracture planes (0°, 15°, 30°, 45°, and 60°). Fluoroscopic images were taken after each turn during screw insertion and analyzed. Initial screw push-off, residual fracture gap at optimal fracture gap reduction, and malreduction were determined in each trial. Statistical analysis was performed via a 1-way analysis of variance followed by Student t tests. RESULTS Malreduction was found to be significantly different between the perpendicular (1.88 mm ± 1.38) and the oblique/longitudinal (0.58 mm ± 0.23) screws. The malreduction increased for the perpendicular screw as the fracture angle increased (60° > 45°=30° > 15° > 0°). Residual fracture gap at optimal fracture gap reduction was also found to be significantly different between the perpendicular (0.97 ± 0.42) and oblique/longitudinal (1.43 ± 1.14) screws. The residual fracture gap increased for the oblique/longitudinal screw as the fracture angle increased, although the oblique/longitudinal screw with a 60° fracture angle was the only configuration significantly larger than all the other configurations. Screw push-off was not found to be significantly different between the oblique/longitudinal screw and perpendicular screw trials. CONCLUSIONS The perpendicular screw had a larger malreduction that increased with fracture angle, whereas the oblique/longitudinal screw had a larger residual fracture gap that increased with fracture angle.
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Affiliation(s)
- John P. Mickley
- The Ohio State University College of Medicine, Columbus, USA
| | - Daniel J. Lynch
- The Ohio State University College of Medicine, Columbus, USA
| | - Adam M. Gordon
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA
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2
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Nguyễn MV, Chaves C, Crenn V, Bellemère P. Percutaneous fixation of scaphoid fractures through the snuffbox: an anatomical study. J Hand Surg Eur Vol 2023; 48:1207-1213. [PMID: 37480277 DOI: 10.1177/17531934231188461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
The aim of the present anatomical study was to assess the dorso-radial approach for percutaneous fixation of scaphoid wist fractures. Through the anatomical snuffbox, cannulated screws or 1.2 mm K-wires were inserted into the scaphoids of 20 fresh-frozen cadavers. No tendon injuries were observed. There were two lesions of the radial artery, and three lesions of the sensory branches of the radial nerve. After dissection and three-dimensional CT reconstruction, the K-wire or screw position was described in relation to the scaphoid centroid and its longitudinal axis. The mean distance between the device and the scaphoid centroid was 2.8 mm (SD 1.4, range 0.6 to 6.1). The mean angle between the device and the scaphoid's longitudinal axis was 29° (SD 11, range 6.5 to 54). Rather than percutaneous fixation, an open approach with a modest incision might be safer for identifying and protecting both the radial artery and the sensory nerves. This approach would make perpendicular fixation possible for specific patterns of scaphoid fracture orientated approximately 60° from the longitudinal axis.
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Affiliation(s)
- Mỹ-Vân Nguyễn
- Institut de la main Nantes Atlantique, Saint Herblain, France
- Orthopaedics and Traumatology Surgery Department, Nantes University Hospital, Nantes, France
| | - Camilo Chaves
- Institut de la main Nantes Atlantique, Saint Herblain, France
| | - Vincent Crenn
- Orthopaedics and Traumatology Surgery Department, Nantes University Hospital, Nantes, France
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3
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Bulstra AEJ, Al-Dirini RMA, Turow A, Oldhoff MGE, Bryant K, Obdeijn MC, Doornberg JN, Jaarsma RL, Bain GI. The influence of fracture location and comminution on acute scaphoid fracture displacement: three-dimensional CT analysis. J Hand Surg Eur Vol 2021; 46:1072-1080. [PMID: 34472394 DOI: 10.1177/17531934211040962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We aimed to assess the influence of fracture location and comminution on acute scaphoid fracture displacement using three-dimensional CT. CT scans of 51 adults with an acute scaphoid fracture were included. Three-dimensional CT was used to assess fracture location, comminution and displacement. Fracture location was expressed as the height of the cortical breach on the volar and dorsal side of the scaphoid relative to total scaphoid length (%), corresponding to the fracture's entry and exit point, respectively. We found a near-linear relation between dorsal fracture location and displacement. As dorsal fracture location became more distal, translation (ulnar, proximal, volar) and angulation (flexion, pronation) of the distal fragment relative to the proximal fragment increased. Comminuted fractures had more displacement. Dorsal fracture location predictably dictates the direction of translation and angulation in displaced scaphoid fractures. Surgeon attention to dorsal fracture location can help identify displacement patterns and provide guidance in adequately reducing a displaced scaphoid fracture.Level of evidence: III.
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Affiliation(s)
- Anne Eva J Bulstra
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Rami M A Al-Dirini
- Medical Devices Research Institute, Flinders University, Adelaide, Australia
| | - Arthur Turow
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Kimberley Bryant
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Job N Doornberg
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, South Australia, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gregory I Bain
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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4
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Aruse O, Immerman I, Badir O, Haj ME, Volk I, Luria S. Scaphoid fracture displacement is not correlated with the fracture angle. J Hand Surg Eur Vol 2021; 46:607-615. [PMID: 33794693 DOI: 10.1177/17531934211004434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture displacement as an indicator of instability. We examined the effect of using different axes on the measurements of angles. CT scans of 133 scaphoid fractures were classified according to the location of the fractures. Using a three-dimensional computer model, we computed four scaphoid axes. For each fracture, we then measured the fracture angle and the direction of the fracture inclination in relation to each one of the axes. We found a correlation between displacement and the angles of proximal fractures using one of these axes (the surface principal component analysis axis). No such correlations were found for waist fractures, which were the majority of fractures. There were significant differences between the measurements made with different axes. The findings indicate that the angle of the fracture and the direction of the fracture inclination are minor factors in the displacement of most scaphoid fractures.Level of evidence: III.
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Affiliation(s)
- Ophir Aruse
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel
| | - Igor Immerman
- Department of Orthopaedic Surgery, University of California San Francisco, CA, USA
| | - Omar Badir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel
| | - Madi El Haj
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel
| | - Ido Volk
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shai Luria
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Orthopedic Surgery Department, Hadassah Medical Center, Jerusalem, Israel
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5
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Ahrend MD, Teunis T, Noser H, Schmidutz F, Richards G, Gueorguiev B, Kamer L. 3D computational anatomy of the scaphoid and its waist for use in fracture treatment. J Orthop Surg Res 2021; 16:216. [PMID: 33761965 PMCID: PMC7988956 DOI: 10.1186/s13018-021-02330-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A detailed understanding of scaphoid anatomy helps anatomic fracture reduction, and optimal screw position. Therefore, we analysed (1) the size and shape variations of the cartilage and osseous surface, (2) the distribution of volumetric bone mineral density (vBMD) and (3) if the vBMD values differ between a peripheral and a central screw pathway? METHODS Forty-three fresh frozen hand specimens (17 females, 26 males) were analysed with high-resolution peripheral quantitative computed tomography (HR-pQCT) and dissected to compute a 3D-statistical osseous and cartilage surface model and a 3D-averaged vBMD model of the scaphoid. 3D patterns were analysed using principal component analysis (PCA). vBMD was analysed via averaging HR-pQCT grey values and virtual bone probing along a central and peripheral pathway. RESULTS (1) PCA displayed most notable variation in length ranging from 1.7 cm (- 2SD) to 2.6 cm (mean) and 3.7 cm (+ 2SD) associated with differences of the width and configuration of the dorsal surface (curved and narrow (4 mm) to a wider width (9 mm)). (2) High vBMD was located in the peripheral zone. Lowest vBMD was observed in the centre and waist. (3) Virtual probing along a peripheral pathway near to the cartilage surfaces for the capitate and lunate allowed the center region to be bypassed, resulting in increased vBMD compared to a central pathway. CONCLUSION High anatomical variations regarding the osseous and cartilage surfaces were associated with three distinct concentrically arranged zones with notable different vBMD. The complex scaphoid anatomy with its waist might alter the strategy of fracture fixation, education and research.
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Affiliation(s)
- Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany. .,AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland.
| | - Teun Teunis
- Plastic Surgery Department, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Hansrudi Noser
- AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland
| | - Florian Schmidutz
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.,AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland.,Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland
| | - Lukas Kamer
- AO Research Institute Davos, Clavadelerstr. 8, Davos, Switzerland
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6
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Daniels AM, Bevers MSAM, Sassen S, Wyers CE, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Hannemann PFW, Poeze M, van den Bergh JP, Janzing HMJ. Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT. J Bone Joint Surg Am 2020; 102:2138-2145. [PMID: 33079896 DOI: 10.2106/jbjs.20.00124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting. METHODS The present study included 91 consecutive patients (≥18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation). RESULTS The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001). CONCLUSIONS In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substantial proportion of fractures-in this study, more than one-third-will be missed by the current application of CT scanning in patients with a clinically suspected scaphoid fracture. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A M Daniels
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - M S A M Bevers
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Sassen
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
| | - C E Wyers
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B van Rietbergen
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - P P M M Geusens
- Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - S Kaarsemaker
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
| | - P F W Hannemann
- Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J P van den Bergh
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands.,Faculty of Medicine, Hasselt University, Belgium
| | - H M J Janzing
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
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7
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Turow A, Bulstra AE, Oldhoff M, Hayat B, Doornberg J, White J, Jaarsma RL, Bain GI. 3D mapping of scaphoid fractures and comminution. Skeletal Radiol 2020; 49:1633-1647. [PMID: 32417943 DOI: 10.1007/s00256-020-03457-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acute and subacute scaphoid fractures were assessed using 3D computer tomography (CT). The aims were to describe fracture morphology, to map fractures onto a 3D scaphoid model and to correlate this to scaphoid anatomy. MATERIALS AND METHODS A retrospective, multicentre database search was performed to identify CT studies of acute and subacute scaphoid fractures. CT scans of scaphoid fractures less than 6 weeks from time of injury were included in this retrospective, multicentre study. CTs were segmented and converted into three-dimensional models. Following virtual fracture reduction, fractures were mapped onto a three-dimensional scaphoid model. RESULTS Seventy-five CT scans were included. The median delay from injury to CT was 29 days. Most studies were in male patients (89%). Most fractures were comminuted (52%) or displaced (64%). A total of 73% of displaced fractures had concomitant comminution. Waist fractures had higher rates of comminution and displacement when compared with all other fractures. Comminution was located along the dorsal ridge and the volar scaphoid waist. CONCLUSION Our study is the first to describe acute fracture morphology using 3D CT and to correlate comminution and displacement to fracture types. The dorsal ridge and volar waist need prudent assessment, especially in waist fractures.
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Affiliation(s)
- Arthur Turow
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia. .,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Anne Eva Bulstra
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Miriam Oldhoff
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | - Batur Hayat
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Job Doornberg
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - John White
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Ruurd L Jaarsma
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Gregory I Bain
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
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8
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Schmidle G, Kastenberger TJ, Kaiser P, Stock K, Benedikt S, Arora R. [3D Imaging for the analysis of scaphoid fractures and non-unions]. HANDCHIR MIKROCHIR P 2020; 52:392-398. [PMID: 32992396 DOI: 10.1055/a-1250-7913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The aim of the present study is to give an overview over the possibilities of 3D imaging in the analysis of scaphoid fractures and non-unions and to discuss them on the base of case studies and literature.
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Affiliation(s)
- Gernot Schmidle
- Medical University Innsbruck, University Hospital for Trauma Surgery
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9
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Luria S. Understanding the Patterns of Deformity of Wrist Fractures Using Computer Analysis. Curr Rheumatol Rev 2020; 16:194-200. [PMID: 32967607 DOI: 10.2174/1573397115666190429144944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/14/2018] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
Computer modeling of the wrist has followed other fields in the search for descriptive methods to understand the biomechanics of injury. Using patient-specific 3D computer models, we may better understand the biomechanics of wrist fractures in order to plan better care. We may better estimate fracture morphology and stability and evaluate surgical indications, design more adequate or effective surgical approaches and develop novel methods of therapy. The purpose of this review is to question the actual advances made in the understanding of wrist fractures using computer models.
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Affiliation(s)
- Shai Luria
- Department of Orthopaedic Surgery, Hadassah Hebrew-University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
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10
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Sasaki T, Makino K, Nimura A, Suzuki S, Kuroiwa T, Koyama T, Okawa A, Terada H, Fujita K. Assessment of grip-motion characteristics in carpal tunnel syndrome patients using a novel finger grip dynamometer system. J Orthop Surg Res 2020; 15:245. [PMID: 32631378 PMCID: PMC7339582 DOI: 10.1186/s13018-020-01773-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Grip strength measurement is widely used in daily medical practice, and it has been reported that the grip strength decreases in patients with carpal tunnel syndrome (CTS). However, conventional grip dynamometers evaluate only the maximum power of total grip strength and cannot measure the time course of grip motion. In this report, we aimed to determine the grip characteristics of CTS patients by measuring the time course of each finger’s grip motion and to analyze the relationship between finger grip strength and subjective symptoms using this new grip system. Methods The grip strength of each finger was measured using the new grip system that has four pressure sensors on the grip parts of each finger of the Smedley grip dynamometer. We analyzed the time course of grip motion and relationship between finger grip strength and subjective symptoms in 104 volunteer and 51 CTS hands. The Japanese Society for Surgery of the Hand version of the Carpal Tunnel Syndrome Instrument (CTSI-JSSH) and the Disability of Arm, Shoulder, and Hand questionnaire (DASH) were used as subjective evaluation scores. Results In the CTS group, the grip time with the index, middle, and ring fingers was longer, and the time at which strength was lost after reaching the maximum was earlier. Patients with severe subjective symptoms tended to not use the index and middle fingers during grip motion. Conclusions This new system that measures each finger’s grip strength at one time and record the time course of grip motion could quantify a patient’s symptoms easily and objectively, which may contribute to the evaluation of hand function.
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Affiliation(s)
- Toru Sasaki
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Makino
- Center for Creative Technology, University of Yamanashi, 4-3-11, Takeda, Kofu, Yamanashi, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shiro Suzuki
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomoyuki Kuroiwa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takafumi Koyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hidetsugu Terada
- Department of Mechatronics, University of Yamanashi, 4-3-11, Takeda, Kofu, Yamanashi, Japan
| | - Koji Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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11
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Vishwanathan K, Patel R, Talwalkar S. Which Headless Compression Screw Produces the Highest Interfragmentary Compression Force in Scaphoid Fracture? Indian J Orthop 2020; 54:548-564. [PMID: 32850017 PMCID: PMC7429644 DOI: 10.1007/s43465-020-00107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Interfragmentary compression at the fracture site facilitates healing. Headless compression screws used to treat scaphoid fractures can be grouped as shank screws, conical tapered screws and double component screws. There has been no meta-analysis of biomechanical studies to compare interfragmentary compression produced by the above screws. METHODS A computerised search of Pubmed, Embase and OVID database was undertaken to identify the studies. We estimated the weighted mean difference of interfragmentary compression (in Newton) with 95% confidence intervals. Random effects model was selected for meta-analysis. RESULTS The pooled estimate of nine studies demonstrated that conical tapered screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 19.96, 95% CI 11.2-28.8, p < 0.0001, I 2 = 99%). The pooled estimate of four studies demonstrated that dual component screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 16.93, 95% CI 12.3-21.6, p < 0.0001, I 2 = 97.7%). The pooled estimate of four studies showed that there was no significant difference in the interfragmentary compression force generated by either conical tapered screw or dual component screw (WMD 3.93, 95% CI - 8.3 to 16.2, p = 0.53, I 2 = 99.7%). There was evidence of minimal publication bias. CONCLUSION Conical tapered screws and dual component screws produced statistically significant higher interfragmentary compression force at the scaphoid fracture site compared to shank screws. There was no difference in the compression force generated by either conical tapered screw or dual component screw.
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, P.O Limda, Waghodia, Vadodara, 391760 India
| | - Ravi Patel
- Pramukhswami Medical College, Charutar Arogya Mandal, Gokal Nagar, Karamsad, 388325 India
| | - Sumedh Talwalkar
- Department of Orthopaedics, Wrightington, Wigan and Leigh NHS Trust, Wrightington, WN6 9EP UK
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Prabhakar P, Wessel L, Nguyen J, Stepan J, Carlson M, Fufa D. Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation. J Wrist Surg 2020; 9:141-149. [PMID: 32257616 PMCID: PMC7112999 DOI: 10.1055/s-0039-3402769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case-control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.
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Affiliation(s)
- Pooja Prabhakar
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Lauren Wessel
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph Nguyen
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | - Jeffrey Stepan
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Michelle Carlson
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Duretti Fufa
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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13
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Luria S, Badir S, Schwarcz Y, Peleg E, Waitayawinyu T. Approach to the Perpendicular Fixation of a Scaphoid Waist Fracture-A Computer Analyzed Cadaver Model. J Hand Surg Am 2020; 45:203-212. [PMID: 31451321 DOI: 10.1016/j.jhsa.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 05/05/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE In scaphoid fracture screw fixation, the screw is commonly placed along the long axis of the bone, without consideration of the fracture plane. This position is not perpendicular to transverse waist fractures or to the more common horizontal oblique fractures. Our aim was to examine the feasibility and describe possible approaches to, placing a screw perpendicular and in the center of the scaphoid waist fracture. METHODS Computed tomography of 12 cadaver wrists was performed in 3 positions to examine possible approaches in flexion, neutral, and extension of the wrist. The scans were evaluated using a 3-dimensional model that simulated horizontal oblique (60°) and transverse (90°) fractures. We examined all possible approaches for screw positioning and their deviation from the axis perpendicular to the fracture and in the center of its plane. RESULTS The preferred approaches for a perpendicular screw in a horizontal oblique fracture were found to be proximal-dorsal in flexion or transtrapezial in the extended or neutral positions (through the volar-radial trapezium). In transverse fractures, the possible approaches were proximal-dorsal or transtrapezial in the flexed or neutral positions and distal in the extended position (volar to volar-radial trapezium). In these approaches, the screw could be placed perpendicularly (deviating by < 10°) and in the center of the fracture in all specimens. CONCLUSIONS According to this model, it appears feasible to place a perpendicular screw in the center of a horizontal oblique waist fracture using a proximal-dorsal approach in flexion or a transtrapezial approach in neutral or extension positions of the wrist. Palpable landmarks may be used as additional guides to direct these approaches according to the clinical setting. CLINICAL RELEVANCE Perpendicular screw fixation of horizontal oblique or transverse scaphoid waist fractures is a possible option, if chosen for its biomechanical advantages.
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Affiliation(s)
- Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Samih Badir
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yonatan Schwarcz
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Peleg
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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14
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Drijkoningen T, Mohamadi A, Luria S, Buijze GA. Scaphoid Fracture Patterns-Part One: Three-Dimensional Computed Tomography Analysis. J Wrist Surg 2019; 8:441-445. [PMID: 31815056 PMCID: PMC6892660 DOI: 10.1055/s-0039-1693050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm 3 ± 0.49 cm 3 standard deviation [SD]) and distal fracture fragments (1.53 cm 3 ± 0.48 cm 3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through-but only directly proximal to-the tubercle suggesting that these would be best classified as distal waist fractures. Conclusion Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. Level of evidence This is a Level IV study.
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Affiliation(s)
- Tessa Drijkoningen
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Geert A. Buijze
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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15
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Drijkoningen T, Mohamadi A, van Leeuwen WF, Schwarcz Y, Ring D, Buijze GA. Scaphoid Fracture Patterns-Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification. J Wrist Surg 2019; 8:446-451. [PMID: 31815057 PMCID: PMC6892654 DOI: 10.1055/s-0039-1692470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification ( P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.
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Affiliation(s)
- Tessa Drijkoningen
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wouter F. van Leeuwen
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yonatan Schwarcz
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas
| | - Geert A. Buijze
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital, Montpellier, France
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Abstract
Most minimally displaced scaphoid fractures and all displaced scaphoid fractures in elite athletes are treated with early fixation to maximally expedite the return to full function. Computed tomographic (CT) scans are recommended in all scaphoid fractures to facilitate a complete understanding of fracture anatomy and to allow for optimal screw placement. Screw placement is important to maximize healing capacity of the fracture and allow for return to sport. Postoperative CT scans can be helpful to evaluate the extent of healing and may allow patients to return to play sooner.
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Affiliation(s)
- Edward W Jernigan
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
| | - Kyle W Morse
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA.
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
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17
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Garala K, Dias J. Scaphoid fracture geometrics: an assessment of location and orientation. J Plast Surg Hand Surg 2019; 53:180-187. [DOI: 10.1080/2000656x.2019.1581789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kanai Garala
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery (AToMS), Undercroft, Leicester General Hospital, Leicester, UK
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18
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Ideal Starting Point and Trajectory of a Screw for the Dorsal Approach to Scaphoid Fractures. J Hand Surg Am 2018; 43:993-999. [PMID: 29779707 DOI: 10.1016/j.jhsa.2018.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 01/24/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the screw starting point and trajectory for the dorsal approach to scaphoid fractures that provides a combination of length and compression at the fracture site. METHODS Computed tomography scans were obtained of 10 scaphoid fractures for 3 common fracture types. A computerized model was generated for each scaphoid. Screw starting point, length, and angle to the fracture plane were analyzed for starting points and trajectories within a safe zone that protected against cortical penetration. A novel analysis was developed to assess a combination of screw length and angle to fracture plane, termed "effective compression length" (ECL). ECL assessed the screw working distance perpendicular to the fracture. Results were analyzed to determine optimal screw starting point and trajectory. RESULTS For proximal pole fractures, a screw perpendicular to the fracture was 9.7 mm from the longitudinal axis starting point (LASP). The screw with the largest ECL was 6.8 mm from the LASP, crossing the fracture at a 67° obliquity. For waist fractures, a perpendicular screw was 7.8 mm from the LASP. The screw with the largest ECL was 6.0 mm away, crossing the fracture at 74°. For distal oblique fractures, a perpendicular screw was 10.2 mm from the LASP. The screw with the largest ECL was 6.4 mm away, crossing the fracture at 70°. A screw with the classic starting point and trajectory crossed the fracture at obliquities of 48°, 51°, and 45° for proximal, waist, and distal fractures, respectively. CONCLUSIONS Scaphoid screws placed with the classic starting point and trajectory cross the fracture at an obliquity. By altering the screw starting point and trajectory, screws with adequate length will be more perpendicular to the fracture plane. CLINICAL RELEVANCE Screw starting point and trajectory for scaphoid fractures may be altered based on fracture type to obtain a long screw that is closer to perpendicular to the fracture.
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19
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MacMahon A, Orr SB, Wessel LE, Meyers KN, Fields K, Jawetz ST, Bartolotta RJ, Fufa D. A CT-based approach with 3D modeling to determine optimal radiographic views of the scaphotrapezial and scaphotrapezoid joints. Clin Imaging 2018; 50:273-279. [PMID: 29727816 DOI: 10.1016/j.clinimag.2018.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To use a CT-based approach with 3D modeling to determine novel radiographic views of the scaphotrapezial (STl) and scaphotrapezoid (STd) joints. MATERIALS AND METHODS Consecutive wrist CT scans excluding those with pathology of the distal radius, scaphoid, trapezium, or trapezoid of subjects between ages 18 and 60 years were retrospectively reviewed. Three-dimensional reconstructions of CT scans were created and best-fit planes of the STl and STd joints were generated. Angles of these planes relative to a distal radial coordinate system were calculated to determine tilt of the wrist and the X-ray beam for novel radiographic views of these joints. RESULTS Fifty eligible wrist CT scans were identified. The mean age was 38 years (range, 18 to 59). For the novel STl PA view, the wrist is supinated 17° from the standard PA view and the X-ray beam is canted 6° caudad. In the STl lateral view, the wrist is pronated 17° from the standard lateral view, and the X-ray beam is canted 20° caudad. In the STd PA tilt view, the wrist is supinated 28° from the standard PA view, and the X-ray beam is canted 13° caudad. In the STd joint lateral tilt view, the wrist is pronated 28° from the standard lateral view, and the X-ray beam is canted 29° caudad. CONCLUSION We describe novel radiographic views of the STl and STd joints based on 3D modeling of wrist CT scans. Further studies are required to assess the efficacy of these views in detecting joint pathology.
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Affiliation(s)
| | - Steven B Orr
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, USA
| | - Lauren E Wessel
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, USA
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, USA
| | - Kara Fields
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, USA
| | - Shari T Jawetz
- Weill Cornell Medical College, New York, USA; Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Roger J Bartolotta
- Weill Cornell Medical College, New York, USA; Department of Radiology, NewYork-Presbyterian Hospital, New York, USA
| | - Duretti Fufa
- Weill Cornell Medical College, New York, USA; Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, USA
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20
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Ten Berg PWL, Dobbe JGG, Brinkhorst ME, Meermans G, Strackee SD, Verstreken F, Streekstra GJ. Scaphoid screw fixation perpendicular to the fracture plane: Comparing volar and dorsal approaches. Orthop Traumatol Surg Res 2018; 104:109-113. [PMID: 29253617 DOI: 10.1016/j.otsr.2017.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To percutaneously fixate a midwaist scaphoid fracture, both volar and dorsal approaches are considered valid options although they may have different screw insertion angles relative to the scaphoid fracture plane influencing fixation stability. In this virtual simulation study, we investigated the accessibility of placing a screw perpendicularly to the fracture plane in transverse and horizontal oblique scaphoid midwaist fracture models and compared standard volar and dorsal approaches. MATERIAL AND METHODS Computed tomography scans of 38 healthy wrists were used to obtain virtual 3-dimensional wrist models in flexion and extension. In case the trapezium in volar approach or the distal radius in dorsal approach obstructed the screw axis perpendicular to the fracture plane, an alternative non-obstructed screw axis was chosen as close as possible to the perpendicular axis. The deviation angle between the best possible non-obstructed screw placement and true perpendicular screw placement was quantified. RESULTS For transverse fractures, the average deviation angle (±standard deviation) was 8° (±5°) in volar approach, and 0° (±0°) in dorsal approach. For horizontal oblique fractures, these angles were 40° (±6°) and 14° (±8°), respectively. DISCUSSION In our simulations, compared to the volar approach, the dorsal approach provided the most precise screw placement perpendicular to the fracture plane, with the largest differences for horizontal oblique fractures. When taken in addition to screw purchase, thread engagement and protrusion risk, information about screw orientation may help surgeons in deciding between percutaneous approaches in scaphoid surgery on which there is currently no consensus. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- P W L Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M E Brinkhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands
| | - G Meermans
- Department of Orthopaedics, Lievensberg Hospital, 4624 VT Bergen Op Zoom, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - F Verstreken
- Department of Orthopaedics, Monica Hospital, 2018 Antwerp, Belgium
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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21
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Luchetti TJ, Hedroug Y, Fernandez JJ, Cohen MS, Wysocki RW. The morphology of proximal pole scaphoid fractures: implications for optimal screw placement. J Hand Surg Eur Vol 2018; 43:73-79. [PMID: 29105589 DOI: 10.1177/1753193417739546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to measure the radiographic parameters of proximal pole scaphoid fractures, and calculate the ideal starting points and trajectories for antegrade screw insertion. Computed tomography scans of 19 consecutive patients with proximal pole fractures were studied using open source digital imaging and communications in medicine (DICOM) imaging measurement software. For scaphoid sagittal measurements, fracture inclination was measured with respect to the scaphoid axis. The ideal starting point for a screw in the proximal pole fragment was then identified on the scaphoid sagittal image that demonstrated the largest dimensions of the proximal pole, and hence the greatest screw thread purchase. Measurements were then taken for a standard screw trajectory in the axis of the scaphoid, and a trajectory that was perpendicular to the fracture line. The fracture inclination in the scaphoid sagittal plane was 25 (SD10) °, lying from proximal palmar to dorsal distal. The fracture inclination in the coronal plane was 9 (SD16) °, angling distal radial to proximal ulnar with reference to the coronal axis of the scaphoid. Using an ideal starting point that maximized the thread purchase in the proximal pole, we measured a maximum screw length of 20 (SD 2) mm when using a screw trajectory that was perpendicular to the fracture line. This was quite different from the same measurements taken in a trajectory in the axis of the scaphoid. We also identified a mean distance of approximately 10 mm from the dorsal fracture line to the ideal starting point. A precise understanding of this anatomy is critical when treating proximal pole scaphoid fractures surgically.
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Affiliation(s)
- Timothy J Luchetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Youssef Hedroug
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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22
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Volk I, Gal J, Peleg E, Almog G, Luria S. Three-dimensional comparison of alternative screw positions versus actual fixation of scaphoid fractures. Injury 2017; 48:1183-1189. [PMID: 28351546 DOI: 10.1016/j.injury.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/23/2017] [Accepted: 03/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The recommended technique for the fixation of a scaphoid waist fracture involves a headless compression screw placed in the proximal fragment center. This is usually accomplished by placing a longitudinal axis screw as visualized by fluoroscopy. The screw length has been shown to have a biomechanical advantage. An alternative to these options, which has been debated in the literature, is a screw placed perpendicular to the fracture plane and in its center. The perpendicular screw may have a biomechanical advantage despite the fact that it may be shorter. This study examined the differences in location and length in actual patients between a screw in the center of the proximal fragment with a longitudinal axis screw, and the actual fixating screw. These were then compared to a perpendicular axis screw. METHODS Pre- and post-operative CT scans of 10 patients with scaphoid waist fractures were evaluated using a 3D computer model. Comparisons were made between the length, location and angle of actual and virtual screw alternatives; namely, a screw along the central third of the proximal fragment (central screw axis) where the scaphoid longitudinal axis was calculated mathematically (longitudinal screw axis) and a screw placed at 90° to the fracture plane and in its center (perpendicular screw axis). RESULTS The longitudinal axis screw was found to be significantly longer than the other axes (28.3mm). There was a significant difference between the perpendicular axis screw and the location and angle of the other screw axis, but it was only shorter than the longitudinal screw (23.6mm versus 25.5mm for the actual screw; ns.). CONCLUSIONS A computed longitudinal axis screw is longer than a central or actual screw placed longitudinally by visual inspection by the surgeon. Although it needs to be placed using computer assisted (CAS) techniques, it may have the biomechanical advantages of a longer screw in a similar trajectory. The perpendicular screw was found to be significantly different in position and angle but not shorter than the actually placed screw. It has biomechanical advantages and does not require visualization with CAS methods, making it the more attractive alternative.
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Affiliation(s)
- Ido Volk
- Dept. of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan Gal
- Dept. of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Peleg
- Dept. of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gil Almog
- Dept. of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shai Luria
- Dept. of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Schwarcz Y, Schwarcz Y, Peleg E, Joskowicz L, Wollstein R, Luria S. Three-Dimensional Analysis of Acute Scaphoid Fracture Displacement: Proximal Extension Deformity of the Scaphoid. J Bone Joint Surg Am 2017; 99:141-149. [PMID: 28099304 DOI: 10.2106/jbjs.16.00021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our goal was to analyze the movement of acute scaphoid waist fracture fragments and adjacent bones in a common coordinate system. Our hypothesis was that the distal scaphoid fragment flexes and pronates and the proximal fragment extends. METHODS Computed tomography (CT) scans of patients diagnosed with an acute scaphoid waist fracture were evaluated using a 3-dimensional (3D) model. The scans of 57 nondisplaced and 23 displaced fractures were compared with a control group of 27 scans showing no pathological involvement of the wrist. Three anatomical landmarks were labeled on the distal and proximal fragments of the scaphoid, the lunate, and the trapezium. Each set of labels formed a triangle representing the bone or fragment. Four landmarks were labeled on the distal radial articular surface and used to create a common coordinate system. The position of each bone or fragment was calculated in reference to these coordinates. RESULTS The displaced fracture group showed significant extension, supination, and volar translation of the proximal scaphoid fragment when compared with the other groups. The lunate tended toward a supinated position, which was not statistically significant. The distal scaphoid fragment and the trapezium showed no movement. CONCLUSIONS In acute displaced scaphoid fractures, it is the proximal fragment that displaces and should be reduced. CLINICAL RELEVANCE The typical "humpback" deformity is actually a "proximal extension" deformity, the consequence of displacement of the proximal fragment of the scaphoid (with the lunate). Manipulating only the proximal fragment (with the lunate) may be technically easier and more effective than manipulating both fragments.
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Affiliation(s)
- Yonatan Schwarcz
- 1Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 2School of Engineering and Computer Science, the Hebrew University, Jerusalem, Israel 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Slutsky DJ, Herzberg G, Shin AY, Buijze GA, Ring DC, Mudgal CS, Leung YF, Dumontier C. Coronal Fractures of the Scaphoid: A Review. J Wrist Surg 2016; 5:194-201. [PMID: 27574573 PMCID: PMC5001190 DOI: 10.1055/s-0036-1585414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
Coronal (or frontal plane) fractures of the scaphoid are distinctly uncommon. There are few published reports of coronal fractures of the scaphoid. This fracture is often missed on the initial X-ray films. A high index of suspicion should exist when there is a double contour of the proximal scaphoid pole on the anteroposterior X-ray view. A computed tomography scan is integral in making the diagnosis. Early recognition is key in salvaging the scaphoid fracture and in preventing articular damage. Level of Evidence IV. Retrospective case series.
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Affiliation(s)
- David J. Slutsky
- The Hand and Wrist Institute, Torrance, California; Department of Orthopedics,
Harbor-UCLA Medical Center, Los Angeles, California
| | - Guillaume Herzberg
- Department of Orthopaedic Surgery, Orthopaedic Upper Limb Surgery Unit, Edouard
Herriot Hospital Claude, Lyon, France
| | - Alexander Y. Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery,
Mayo Clinic, Rochester, Minnesota
| | - Geert A. Buijze
- Department of Orthopedic Surgery, Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
| | - David C. Ring
- Department of Orthopedic Surgery, Dell Medical School, University of Texas,
Austin, Texas
| | - Chaitanya S. Mudgal
- Department of Orthopedic Surgery, Harvard Medical School, Boston,
Massachusetts
| | - Yuen-Fai Leung
- Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital, Hong
Kong
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Ten Berg PW, Drijkoningen T, Strackee SD, Buijze GA. Classifications of Acute Scaphoid Fractures: A Systematic Literature Review. J Wrist Surg 2016; 5:152-159. [PMID: 27104083 PMCID: PMC4838473 DOI: 10.1055/s-0036-1571280] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 01/02/2023]
Abstract
Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes. The intention was to improve data comparison between studies using heterogeneous fracture descriptions. Methods We performed a systematic review of the literature based on a search of medical literature from 1950 to 2015, and a manual search using the reference lists in relevant book chapters. Only original descriptions of classifications of acute scaphoid fractures in adults were included. Popularity was based on citation index as reported in the databases of Web of Science (WoS) and Google Scholar. Articles that were cited <10 times in WoS were excluded. Results Our literature search resulted in 308 potentially eligible descriptive reports of which 12 reports met the inclusion criteria. We distinguished 13 different (sub) classification systems based on (1) fracture location, (2) fracture plane orientation, and (3) fracture stability/displacement. Based on citations numbers, the Herbert classification was most popular, followed by the Russe and Mayo classifications. All classification systems were based on plain radiography. Conclusions Most classification systems were based on fracture location, displacement, or stability. Based on the controversy and limited reliability of current classification systems, suggested research areas for an updated classification include three-dimensional fracture pattern etiology and fracture fragment mobility assessed by dynamic imaging.
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Affiliation(s)
- Paul W. Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa Drijkoningen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simon D. Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert A. Buijze
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Beutel BG, Melamed E, Hinds RM, Gottschalk MB, Capo JT. Mechanical Evaluation of Four Internal Fixation Constructs for Scaphoid Fractures. Hand (N Y) 2016; 11:72-7. [PMID: 27418893 PMCID: PMC4920514 DOI: 10.1177/1558944715614889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of this study was to compare the mechanical performance of 4 different constructs for fixation of oblique scaphoid fractures. METHODS Twenty-eight synthetic scaphoids underwent an oblique osteotomy along the dorsal sulcus. Each was randomly assigned to fixation by 1 of 4 methods: two 1.5-mm headless compression screws, one 2.2-mm screw, one 3-mm screw, or a 1.5-mm volar variable-angle plate. After fixation, scaphoids were potted at a 45° angle and loaded at the distal pole by a hydraulically driven mechanical testing system plunger until the fixation failed. Excursion and load were measured with a differential transformer and load cell, respectively. From these data, the stiffness, load-to-failure, and maximum displacement of each construct were calculated. RESULTS The 2.2-mm screw demonstrated the highest stiffness and the two 1.5-mm screws had the lowest. However, there were no significant differences among the fixation methods in terms of stiffness. Both 2.2- and 3-mm screw constructs had significantly higher loads-to-failure than two 1.5-mm screws. The maximum load for the plate approached, but did not achieve, statistical significance compared with the 1.5-mm screws. There was no significant difference among constructs in displacement. CONCLUSIONS All constructs demonstrated similar mechanical properties that may provide sufficient stability for effective clinical use. Given their significantly higher loads-to-failure, a 2.2- or 3-mm screw may be superior to two 1.5-mm screws for fixation of unstable scaphoid fractures. The volar plate did not have superior mechanical characteristics to the compression screws.
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Affiliation(s)
- Bryan G. Beutel
- NYU Hospital for Joint Diseases, New York, NY, USA,Bryan G. Beutel, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | | | | | | | - John T. Capo
- NYU Hospital for Joint Diseases, New York, NY, USA
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Gruszka D, Herr R, Hely H, Hofmann P, Klitscher D, Hofmann A, Rommens PM. Impact of Different Screw Designs on Durability of Fracture Fixation: In Vitro Study with Cyclic Loading of Scaphoid Bones. PLoS One 2016; 11:e0145949. [PMID: 26741807 PMCID: PMC4704798 DOI: 10.1371/journal.pone.0145949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The use of new headless compression screws (HCSs) for scaphoid fixation is growing, but the nonunion rate has remained constant. The aim of this study was to compare the stability of fixation resulting from four modern HCSs using a simulated fracture model to determine the optimal screw design(s). METHODS We tested 40 fresh-frozen cadaver scaphoids treated with the Acumed Acutrak 2 mini (AA), the KLS Martin HBS2 midi (MH), the Stryker TwinFix (ST) and the Synthes HCS 3.0 with a long thread (SH). The bones with simulated fractures and implanted screws were loaded uniaxially into flexion for 2000 cycles with a constant bending moment of 800 Nmm. The angulation of the fracture fragments was measured continuously. Data were assessed statistically using the univariate ANOVA test and linear regression analysis, and the significance level was set at p < 0.05. RESULTS The median angulation of bone fragments φ allowed by each screw was 0.89° for AA, 1.12° for ST, 1.44° for SH and 2.36° for MH. With regards to linear regression, the most reliable curve was achieved by MH, with a coefficient of determination of R2 = 0.827. This was followed by AA (R2 = 0.354), SH (R2 = 0.247) and ST (R2 = 0.019). Data assessed using an adapted ANOVA model showed no statistically significant difference (p = 0.291) between the screws. CONCLUSIONS The continuous development of HCSs has resulted in very comparable implants, and thus, at this time, other factors, such as surgeons' experience, ease of handling and price, should be taken into consideration.
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Affiliation(s)
- Dominik Gruszka
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Robert Herr
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Hans Hely
- Physics Division, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Peer Hofmann
- Physics Division, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Daniela Klitscher
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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Ten Berg PWL, Strackee SD. A Rare Case of a Vertical Oblique Scaphoid Fracture Nonunion. J Hand Surg Am 2016; 41:155. [PMID: 26710748 DOI: 10.1016/j.jhsa.2015.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Paul W L Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bain GI, Turow A, Phadnis J. Dorsal Plating of Unstable Scaphoid Fractures and Nonunions. Tech Hand Up Extrem Surg 2015; 19:95-100. [PMID: 26053203 DOI: 10.1097/bth.0000000000000087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Achieving stable fixation of displaced acute and chronic nonunited scaphoid fractures continues to be a challenge for the treating surgeon. The threaded compression screw has been the mainstay of treatment of these fractures for the last 3 decades; however, persistent nonunion after screw fixation has prompted development of new techniques. Recent results of volar buttress plating have been promising. We describe a novel technique of dorsal scaphoid plating. In contrast to volar plating, the dorsal plate is biomechanically more favorable as it utilizes the tension side of the scaphoid bone for dynamic compression. Dorsal scaphoid plating provides a more stable construct than the traditional Herbert screw and mitigates the need for vascular or corticocancellous bone grafting in most cases.
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Affiliation(s)
- Gregory I Bain
- *Flinders University, Adelaide †Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Abstract
The April 2015 Wrist & Hand Roundup360 looks at: Non-operative hand fracture management; From the sublime to the ridiculous?; A novel approach to carpal tunnel decompression; Osteoporosis and functional scores in the distal radius; Ulnar variance and force distribution; Tourniquets in carpal tunnel under the spotlight; Scaphoid fractures reclassified; Osteoporosis and distal radial fracture fixation; PROMISing results in the upper limb
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