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Xie RG. In vivo non-contact regions of proximal scaphoid in six extreme wrist positions. BMC Musculoskelet Disord 2024; 25:448. [PMID: 38844912 PMCID: PMC11155112 DOI: 10.1186/s12891-024-07561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw. MATERIALS AND METHODS Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions. RESULTS Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension. CONCLUSIONS Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.
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Affiliation(s)
- Ren-Guo Xie
- Department of Hand Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, 650 New Songjiang Road, Songjiang, Shanghai, 201620, China.
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu, 226001, China.
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Rong C, Zhang Q, Zhu S, Zhang G, Zeng J, Han Q, Guo Y. 3D printed guide-assisted percutaneous screw fixation for minimally displaced scaphoid waist fractures with delayed diagnosis or presentation. BMC Musculoskelet Disord 2024; 25:127. [PMID: 38341564 PMCID: PMC10858476 DOI: 10.1186/s12891-024-07243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert's B2) with delayed diagnosis or presentation. METHODS From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient's preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. RESULTS All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6-10 weeks). At a mean follow-up of 7.7 months (6-13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. CONCLUSIONS Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts.
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Affiliation(s)
- Cunmin Rong
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China.
| | - Qinglin Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Shaobo Zhu
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Guanghui Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Junhao Zeng
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Qingluan Han
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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Putnam J. Rethinking Scaphoid Fixation. Hand Clin 2023; 39:597-604. [PMID: 37827612 DOI: 10.1016/j.hcl.2023.05.007] [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: 10/14/2023]
Abstract
Scaphoid fixation, whether for acute injuries or nonunion, is made challenging by the small and intra-articular nature of the most commonly fractured carpal bone. The purpose of this article is to review the techniques to simplify scaphoid fixation and to optimize healing and early return to activity.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Cheng C, Jiang Z, Sun H, Hu J, Ouyang Y. Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft. J Orthop Surg Res 2023; 18:52. [PMID: 36653796 PMCID: PMC9847075 DOI: 10.1186/s13018-023-03529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment. PURPOSE This study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes. METHODS It was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period. RESULTS Significant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients. CONCLUSIONS The arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.
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Affiliation(s)
- Cong Cheng
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Zongyuan Jiang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Haoran Sun
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Jiaping Hu
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Yanggang Ouyang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
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Guo Y, Ma W, Zlotolow D, Wang C, Tong D, Liu K. A Comparison Between Robotic-Assisted Scaphoid Screw Fixation and a Freehand Technique for Acute Scaphoid Fracture: A Randomized, Controlled Trial. J Hand Surg Am 2022; 47:1172-1179. [PMID: 36253198 DOI: 10.1016/j.jhsa.2022.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/30/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We compared robotic-assisted scaphoid screw fixation to conventional technique in terms of accuracy, surgical times, radiation exposure, and clinical outcomes, including range of motion, grip strength, functional score, and complications. METHODS This study was a registered, prospective, randomized, controlled trial. From May 2019 to December 2019, 1 surgeon performed 18 robotic-assisted and 18 conventional scaphoid screw fixations and these patients were eligible for participation in this study. Surgical time, including the time of the overall procedure, set-up time, and time for ideal guidewire placement, was recorded. The number of guidewire attempts also was recorded. All patients were evaluated clinically and radiographically at follow-up with respect to the severity of pain, wrist motion, grip strength, complications, and Mayo modified wrist score. RESULTS The average set-up time and overall time of the procedure were longer in the robotic-assisted than in the conventional groups, while the mean guidewire insertion time and the mean guidewire attempts was less in the robotic-assisted group than that of the conventional group. The overall radiation exposure was lower in the robotic group. CONCLUSIONS Robotic-assisted technique provided a useful tool to improve implantation accuracy and shorten radiation exposure. Additional cost and prolonged duration of surgery without evidence of improved clinical scores may limit widespread acceptance of this technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, The Fourth Clinical College of Peking University, Beijing, China.
| | - Wei Ma
- Department of Orthopedics, Air Force Medical Center, Beijing, China
| | - Dan Zlotolow
- Department of Orthopedics, Shriners Hospital for Children, Philadelphia, PA
| | - Chao Wang
- Department of Epidemiology and Biostatistics, Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Dedi Tong
- Department of Hand Surgery, Beijing Jishuitan Hospital, The Fourth Clinical College of Peking University, Beijing, China
| | - Kun Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, The Fourth Clinical College of Peking University, Beijing, China
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Abstract
The scaphoid is predisposed to nonunion after fracture because of its tenuous blood supply and propensity for delayed diagnosis. Many surgical techniques exist and continue to be developed to treat scaphoid non-unions. However, with variability in patient presentation, differences in nonunion location and type, and multiple bone graft sources and fixation options, selecting a surgical strategy proves a difficult task. The goal of this article is to provide an updated review of surgical strategies used to treat scaphoid nonunions. Particular attention is paid to methods of fixation as well as the ongoing debate over indications for structural and vascularized bone grafting. [Orthopedics. 2022;45(5):e235-e242.].
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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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