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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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Yong M, Liu E, Tee R, Zhang X, Tham S. Determining the optimal radiologic wrist and forearm position to visualize screw protrusion in scaphoid fixation. ANZ J Surg 2023. [PMID: 36869408 DOI: 10.1111/ans.18362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Surgical fixation of scaphoid fractures may result in unrecognized screw protrusion and subsequent cartilage damage to the adjacent joints. The purpose of this study was to use a three-dimensional (3D) scaphoid model to determine the wrist and forearm positioning that will allow intra-operative fluoroscopic visualization of screw protrusions. METHODS Two 3D scaphoid models, with the wrist in neutral and 20° ulnar deviated, were reconstructed from a cadaveric wrist using the Mimics software. The scaphoid models were divided into three segments and further divided into four quadrants in each of the three segments along the scaphoid axes. Two virtual screws, with a 2 and 1 mm groove from the distal border, were placed so that the screws protrude from each quadrant. The wrist models were rotated along the long axis of the forearm and the angles at which the screw protrusions were visualized were recorded. RESULTS One-millimetre screw protrusions were visualized at a narrower range of forearm rotation angles compared to 2 mm screw protrusions. One-millimetre screw protrusions in the middle dorsal ulnar quadrant could not be detected. Visualization of the screw protrusion in each quadrant varied with forearm and wrist positioning. CONCLUSION In this model, all screw protrusions, except 1 mm protrusions in the middle dorsal ulnar quadrant, were visualized with the forearm in pronation, supination or in the mid-pronation position and with the wrist in neutral or 20° ulnar deviated.
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Affiliation(s)
- Melodi Yong
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Edward Liu
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Richard Tee
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Xin Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute / St Vincents Institute, Melbourne, Victoria, Australia
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Chen C, Qi S, Zhou K, Lu T, Ning H, Xiao R. Pairwise attention-enhanced adversarial model for automatic bone segmentation in CT images. Phys Med Biol 2023; 68. [PMID: 36634367 DOI: 10.1088/1361-6560/acb2ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/12/2023] [Indexed: 01/14/2023]
Abstract
Objective. Bone segmentation is a critical step in screw placement navigation. Although the deep learning methods have promoted the rapid development for bone segmentation, the local bone separation is still challenging due to irregular shapes and similar representational features.Approach. In this paper, we proposed the pairwise attention-enhanced adversarial model (Pair-SegAM) for automatic bone segmentation in computed tomography images, which includes the two parts of the segmentation model and discriminator. Considering that the distributions of the predictions from the segmentation model contains complicated semantics, we improve the discriminator to strengthen the awareness ability of the target region, improving the parsing of semantic information features. The Pair-SegAM has a pairwise structure, which uses two calculation mechanics to set up pairwise attention maps, then we utilize the semantic fusion to filter unstable regions. Therefore, the improved discriminator provides more refinement information to capture the bone outline, thus effectively enhancing the segmentation models for bone segmentation.Main results. To test the Pair-SegAM, we selected the two bone datasets for assessment. We evaluated our method against several bone segmentation models and latest adversarial models on the both datasets. The experimental results prove that our method not only exhibits superior bone segmentation performance, but also states effective generalization.Significance. Our method provides a more efficient segmentation of specific bones and has the potential to be extended to other semantic segmentation domains.
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Affiliation(s)
- Cheng Chen
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, People's Republic of China
| | - Siyu Qi
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, People's Republic of China
| | - Kangneng Zhou
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, People's Republic of China
| | - Tong Lu
- Visual 3D Medical Science and Technology Development Co. Ltd, Beijing 100082, People's Republic of China
| | - Huansheng Ning
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, People's Republic of China
| | - Ruoxiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, People's Republic of China.,Shunde Innovation School, University of Science and Technology Beijing, Foshan 100024, People's Republic of China
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How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study. Arch Orthop Trauma Surg 2022; 142:905-911. [PMID: 33417029 DOI: 10.1007/s00402-020-03702-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To date, only few studies have been performed on the accuracy of manual angle manipulation during orthopedic surgery. This cadaver study was aimed at quantitatively assessing the accuracy of manual angle manipulation performed by orthopedic surgeons according to their surgical experience and comparing it with manipulation performed with the assistance of a digital goniometer. MATERIALS AND METHODS Six lower-leg specimens of fresh-frozen human cadavers were subjected to angle manipulation performed via Kirschner wire (K-wire) insertion. K-wires were inserted manually and with the assistance of a digital goniometer at target angles of 0°, 30°, and 60° by three operators who had different levels of experience in orthopedic surgery. The accuracy of the insertion angles at the target angles was evaluated using computed tomography. RESULTS The mean angle error in the manual angle manipulation was 8.8° (standard deviation [SD] 6.0). When the target angles were set to 0°, 30°, and 60°, the identified angle errors were 6.1° (SD 4.3), 8.8° (SD 6.6), and 11.7° (SD 5.6), respectively, and each value did not show any significant difference among the operators. With the assistance of a digital goniometer, the mean (SD) angle error was significantly improved to 2.1° (1.1°) (p < 0.001). The amount of improvement in accuracy significantly increased as the target angle increased (p = 0.01). CONCLUSION This cadaver study quantified the inaccuracy of manual angle manipulation in orthopedic surgery and showed that these inaccuracies can be improved using an assistive device. These results support the need to develop a device that can compensate manual angle manipulation in orthopedic surgery.
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Sharpe FE, McCarty CP, Goo C, Kim N, Park SH, Ebramzadeh E. Cross-Sectional Areas and Volumes Occupied by Implants in Simulated Scaphoid Fractures. J Hand Surg Am 2022; 47:228-236. [PMID: 34887135 DOI: 10.1016/j.jhsa.2021.10.019] [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: 02/22/2021] [Revised: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study determined the volume of bone replaced by an implant at the proximal and distal poles of simulated scaphoid fractures. We also measured the cross-sectional area of the implant relative to the cross-sectional area of the scaphoid at 2 different simulated fracture locations. METHODS Microcomputed tomograhy scans of 7 cadaveric scaphoids were used to create 3-dimensional models in which transverse proximal pole and midwaist fractures were simulated. The volume occupied by 5 commonly used implants and the cross-sectional area occupied at the surface of the fractures was measured using a computer modeling software. RESULTS For simulated proximal pole fractures, the implants replaced 1.5%-7.4% of the fracture cross-sectional area and 1.2%-6.4% of the proximal fragment bone volume. For midwaist fractures, the implants replaced 1.5%-6.8% of the fracture cross-sectional area and 1.8%-4.6% of the proximal pole volume. Although the different implant designs replaced different areas and volumes, all these differences were small and below 4%. CONCLUSIONS This study provides data that relate to one aspect of fracture healing, specifically, the surface area occupied by 5 different implants in proximal and midwaist scaphoid fractures as well as the volume of bone replaced by the implant. CLINICAL RELEVANCE As opposed to the impression provided by 2-dimensional planar imaging, when studied using a 3-dimensional model, the volume and surface area replaced by an implant represent a minimal percentage of scaphoid bone, suggesting a negligible clinical effect.
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Affiliation(s)
- Frances E Sharpe
- Department of Hand and Orthopedic Surgery, Southern California Permanente Medical Group, Fontana Medical Center, Fontana, CA; Department of Orthopedic Surgery University of Southern California Keck School of Medicine, Fontana Medical Center, Fontana, CA.
| | - Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Connor Goo
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Nicolas Kim
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
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Chen C, Liu B, Zhou K, He W, Yan F, Wang Z, Xiao R. CSR-Net: Cross-Scale Residual Network for multi-objective scaphoid fracture segmentation. Comput Biol Med 2021; 137:104776. [PMID: 34461504 DOI: 10.1016/j.compbiomed.2021.104776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
The scaphoid is located in the carpals. Owing to the body structure and location of the scaphoid, scaphoid fractures are common and it is difficult to heal. Three-dimensional reconstruction of scaphoid fracture can accurately display the fracture surface and provide important support for the surgical plan involving screw placement. To achieve this goal, in this study, the cross-scale residual network (CSR-Net) is proposed for scaphoid fracture segmentation. In the CSR-Net, the features of different layers are used to achieve fusion through cross-scale residual connection, which realizes scale and channel conversions between the features of different layers. It can establish close connections between different scale features. The structures of the output layer and channel are designed to establish the CSR-Net as a multi-objective architecture, which can realize scaphoid fracture and hand bone segmentations synchronously. In this study, 65 computed tomography images of scaphoid fracture are tested. Quantitative metrics are used for assessment, and the results obtained show that the CSR-Net achieves higher performance in hand bone and scaphoid fracture segmentations. In the visually detailed display, the fracture surface is clearer and more intuitive than those obtained from other methods. Therefore, the CSR-Net can achieve accurate and rapid scaphoid fracture segmentation. Its multi-objective design provides not only an accurate digital model, but also a prerequisite for navigation in the hand bone.
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Affiliation(s)
- Cheng Chen
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Bo Liu
- The Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Kangneng Zhou
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Wanzhang He
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Fei Yan
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Zhiliang Wang
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Ruoxiu Xiao
- The School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China; The Institute of Artificial Intelligence, University of Science and Technology Beijing, Beijing, 100083, China.
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Huntington LS, Mandaleson A, Hik F, Ek ETH, Ackland DC, Tham SKY. Measurement of Scaphoid Bone Microarchitecture: A Computed Tomography Imaging Study and Implications for Screw Placement. J Hand Surg Am 2020; 45:1185.e1-1185.e8. [PMID: 32723573 DOI: 10.1016/j.jhsa.2020.05.028] [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] [Received: 05/05/2019] [Revised: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE High bone density and quality is associated with improved screw fixation in fracture fixation. The objective of this study was to assess bone density and quality in the proximal and distal scaphoid to determine optimum sites for placement of 2 screws in scaphoid fracture fixation. METHODS Twenty-nine cadaveric human scaphoid specimens were harvested and scanned using micro-computed tomography. Bone density (bone volume fraction) and bone quality (relative bone surface area, trabecular number, and trabecular thickness) were evaluated in 4 quadrants within each of the proximal and distal scaphoid. RESULTS The proximal radial quadrant of the scaphoid had significantly greater bone volume than the distal ulnar (mean difference, 33.2%) and distal volar quadrants (mean difference, 32.3%). There was a significantly greater trabecular number in the proximal radial quadrant than in the distal ulnar (mean difference, 16.7%) and in the distal volar quadrants (mean difference, 15.9%) and between the proximal ulnar and the distal ulnar quadrants (mean difference, 12%). There was a significantly greater bone surface area in the proximal radial and distal radial quadrants than in the distal ulnar and distal volar quadrants. There were no significant differences in trabecular thickness between the 8 analyzed quadrants CONCLUSIONS: Although there are differences in bone volume, trabecular number, and bone surface area between the proximal pole of the scaphoid and that of the distal pole, there were no significant differences in the bone quality (trabecular thickness, trabecular number, and relative bone surface area) and density (bone volume fraction) between the 4 quadrants of the proximal or distal pole of the cadaveric scaphoids studied. CLINICAL RELEVANCE Insertion of 2 headless compression screws can be determined by ease of surgical access and ease of screw positioning and not by differences in bone quality or density of the proximal or distal scaphoid.
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Affiliation(s)
- Lachlan S Huntington
- Department of Biomedical Engineering, University of Melbourne, Parkville; Melbourne Medical School, University of Melbourne, Parkville
| | - Avanthi Mandaleson
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Freya Hik
- Department of Biomedical Engineering, University of Melbourne, Parkville
| | - Eugene T H Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville
| | - Stephen K Y Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria.
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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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Lucenti L, Lutsky KF, Jones C, Kazarian E, Fletcher D, Beredjiklian PK. Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement. J Wrist Surg 2020; 9:34-38. [PMID: 32025352 PMCID: PMC7000263 DOI: 10.1055/s-0039-1698745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
Background Scaphoid waist fractures are often treated using headless compression screws using dorsal or volar approaches. Objectives The purpose of this study is to compare differences in screw position using a volar (retrograde) or dorsal (antegrade) approach. Patients and Methods A total of 82 patients were retrospectively evaluated: 41 treated with a volar and 41 with a dorsal approach were selected. Postoperative radiographs were reviewed by three observers who rated screw location in the proximal pole, waist, and distal pole. Results Thirty-four patients (83%) in the antegrade group had central screw placement in the waist of the scaphoid in posteroanterior and lateral planes compared with 14 (34.9%) in the retrograde group ( p < 0.05). For the antegrade group, the screw was central in 217 of 246 zones (88.2%) compared with 127 of 246 (51.6%) in the retrograde group ( p < 0.05). Conclusions The dorsal antegrade approach appears to allow the surgeon to achieve central screw placement along all three scaphoid regions. Level of Evidence This is Level III study.
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Affiliation(s)
- Ludovico Lucenti
- Department of Orthopaedic Surgery, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Italy
| | - Kevin F. Lutsky
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Christopher Jones
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | | | - Daniel Fletcher
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Pedro K. Beredjiklian
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Hand Surgery, Rothman Institute, Philadelphia, Pennsylvania
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