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Gvozdenovic R, Kongensgaard TB. Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting. J Hand Surg Eur Vol 2023; 48:903-910. [PMID: 37066665 DOI: 10.1177/17531934231166343] [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] [Indexed: 04/18/2023]
Abstract
This study primarily aimed to report the outcome of the arthroscopic cancellous bone grafting technique for treating scaphoid nonunion. The secondary aim was to compare the bone union rate and time, and the ability to correct the angulation of the scaphoid, between arthroscopically treated patients (n = 27), and patients treated with open cancellous bone grafting (n = 27). Nine surgeons (two in the arthroscopic and seven in the open group) with Level III experience operated on the patients. The pain score, grip strength and Quick Disability of the Arm, Shoulder and Hand score improved significantly after the arthroscopic treatment (p = 0.0001). Arthroscopic cancellous bone grafting achieved union in 25 out of 27 patients. A retrospective comparison with open cancellous bone grafting showed four nonunions. Arthroscopically treated patients healed 5.4 weeks faster compared with the open group (p = 0.033). Patients treated with open grafting had a higher risk of failure (odds ratio = 2.17), although this was not found significant (p = 0.39). The open method corrected the angulation deformity better (dorsal cortical angle correction of 4°) than the arthroscopic method (dorsal cortical angle correction of 1°), but this was not statistically significant neither within the groups (p = 0.55, p = 0.87) nor postoperatively between the groups (p = 0.98). The height-to-length ratio was not different before and after the surgery for the arthroscopic group (p = 0.44) and the open group (p = 0.27), or postoperatively between the groups (p = 0.44).Level of evidence: III.
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Affiliation(s)
- Robert Gvozdenovic
- Department of Hand Surgery, Herlev and Gentofte University Hospital of Copenhagen, Hellerup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, Copenhagen N, Denmark
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Schriever T, Wilcke M. Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study. J Hand Surg Eur Vol 2023; 48:20-26. [PMID: 36165430 DOI: 10.1177/17531934221125355] [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] [Indexed: 02/03/2023]
Abstract
The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5-10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height-length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity (n = 33) and no deformity (n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function.Level of evidence: IV.
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Affiliation(s)
- Thorsten Schriever
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
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Bevers MSAM, Wyers CE, Daniels AM, Audenaert EA, van Kuijk SMJ, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Janzing HMJ, Hannemann PFW, Poeze M, van den Bergh JP. Association between bone shape and the presence of a fracture in patients with a clinically suspected scaphoid fracture. J Biomech 2021; 128:110726. [PMID: 34534791 DOI: 10.1016/j.jbiomech.2021.110726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Scaphoid fractures are difficult to diagnose with current imaging modalities. It is unknown whether the shape of the scaphoid bone, assessed by statistical shape modeling, can be used to differentiate between fractured and non-fractured bones. Therefore, the aim of this study was to investigate whether the presence of a scaphoid fracture is associated with shape modes of a statistical shape model (SSM). Forty-one high-resolution peripheral quantitative computed tomography (HR-pQCT) scans were available from patients with a clinically suspected scaphoid fracture of whom 15 patients had a scaphoid fracture. The scans showed no motion artefacts affecting bone shape. The scaphoid bones were semi-automatically contoured, and the contours were converted to triangular meshes. The meshes were registered, followed by principal component analysis to determine mean shape and shape modes describing shape variance. The first five out of the forty shape modes cumulatively explained 87.8% of the shape variance. Logistic regression analysis was used to study the association between shape modes and fracture presence. The regression models were used to classify the 41 scaphoid bones as fractured or non-fractured using a cut-off value that maximized the sum of sensitivity and specificity. The classification of the models was compared with fracture diagnosis on HR-pQCT. A regression model with four shape modes had an area under the ROC-curve of 72.3% and correctly classified 75.6% of the scaphoid bones (fractured: 60.0%, non-fractured: 84.6%). To conclude, fracture presence in patients with a clinically suspected scaphoid fracture appears to be associated with the shape of the scaphoid bone.
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Affiliation(s)
- Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anne M Daniels
- NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert van Rietbergen
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Sjoerd Kaarsemaker
- Department of Orthopedic Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | | | - Pascal F W Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium.
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Guldbrandsen CW, Radev DI, Gvozdenovic R. Normal ranges for measurements of the scaphoid bone from sagittal computed tomography images. J Hand Surg Eur Vol 2021; 46:594-599. [PMID: 33459143 PMCID: PMC8226418 DOI: 10.1177/1753193420987522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to determine normal values of three parameters commonly used to determine malunion by investigating intact scaphoids on sagittal computed tomography images from healthy individuals. We analysed 62 normal scaphoids and found the mean height-length ratio, lateral intrascaphoid angle and dorsal cortical angle to be 0.58, 27° and 128°, respectively. These measurements had good-to-excellent, poor-to-moderate and moderate-to-good inter- and intra-rater reliabilities, respectively. This study provides information on normal parameters of the scaphoid that may inform clinical decision making when assessing malunion. We suggest that the lateral intrascaphoid angle should be used with great caution as a measure of deformity.Level of evidence: III.
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Affiliation(s)
- Cæcilie W. Guldbrandsen
- Department of Hand Surgery, Herlev/Gentofte
University Hospital of Copenhagen, Hellerup, Denmark,Cæcilie W. Guldbrandsen, Department of Orthopedic
Surgery, Hand Surgery Unit, Herlev/Gentofte University Hospital, Gentofte Hospitalsvej 17,
st., 2900 Hellerup, Denmark.
| | - Dimitar I. Radev
- Department of Radiology, Bispebjerg and
Frederiksberg Hospital, Copenhagen, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte
University Hospital of Copenhagen, Hellerup, Denmark
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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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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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Caiti G, Dobbe JGG, Strackee SD, Strijkers GJ, Streekstra GJ. Computer-Assisted Techniques in Corrective Distal Radius Osteotomy Procedures. IEEE Rev Biomed Eng 2020; 13:233-247. [DOI: 10.1109/rbme.2019.2928424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
The scaphoid is the most commonly fractured bone in the wrist but 20% to 40% of scaphoid fractures are radiographically occult. Delayed or misdiagnosis can have significant consequences with late complications such as nonunion, malunion, or the development of avascular necrosis in the proximal pole. After initial negative radiographs, advanced cross-sectional imaging, including CT and MRI, ultimately may provide more accurate and rapid diagnosis than conventional radiography. With chronic fractures, the preferred modality depends on the clinical question. New techniques are evolving that will further advance imaging for diagnosis and treatment of scaphoid fractures.
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Affiliation(s)
- Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Matthew A Frick
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Jane M Matsumoto
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47:445-453. [DOI: 10.1111/vsu.12776] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Bill Oxley
- Willows Referral Service; Solihull United Kingdom
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10
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Quan Q, Hong L, Chang B, Liu R, Zhu Y, Peng J, Zhao Q, Lu S. The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views. PLoS One 2017; 12:e0170677. [PMID: 28114317 PMCID: PMC5256911 DOI: 10.1371/journal.pone.0170677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to simulate and calculate the probability of iatrogenic perforation of the scaphoid cortical bone when internal fixation appeared to be safe on radiographs. The results will assist surgeons in determining proper screw placement. METHODS Thirty scaphoids were reconstructed using computed tomography data and image-processing software. Different central axes were determined by the software to simulate the surgical views. The safe zone (SZ) and risk zone (RZ) were identified on the axial projection radiographs by comparing the scaphoid bone stenosis measured by the fluoroscopic radiographs with a three-dimensional reconstruction of the scaphoid stenosis. Each original axial projection radiograph was zoomed and compiled to match a calculated average image. The RZ, SZ, and probability of perforations in various quadrants were calculated. RESULTS Using a volar view (approach), the mean risks of cortical perforation were 25% with screws and 36% with k-wires. Using a dorsal view (approach), the mean risks of cortical perforation were 18% with screws and 30% with k-wires. A high risk of perforation was detected at the ulnar-dorsal zone. CONCLUSION Surgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, particularly in the ulnar-dorsal and radial-dorsal quadrants, because such screws are likely to perforate the cortex. The position of the internal fixator should be assessed using a diagram outlining the various SZs. Therapeutic, Level III.
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Affiliation(s)
- Qi Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Lei Hong
- Department of Orthopedic Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Biao Chang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ruoxi Liu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yun Zhu
- School of the Biomedical of Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU), Hong Kong, China
| | - Jiang Peng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Qing Zhao
- Department of Orthopedic Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
- * E-mail: (SL); (QZ)
| | - Shibi Lu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
- * E-mail: (SL); (QZ)
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Estimating Scaphoid Lengths Using Anatomical Measurements in the Wrist. J Hand Surg Am 2016; 41:e279-84. [PMID: 27497802 DOI: 10.1016/j.jhsa.2016.07.053] [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: 10/30/2015] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE In reconstructive surgery of scaphoid nonunions with humpback deformity, some surgeons recommend restoration of the normal scaphoid length whereas others overexpand the normal length to ensure carpal realignment and prevent late collapse. To be able to define overexpansion and investigate which levels of overexpansion yield optimal clinical results, a precise method for estimating the original scaphoid length is required. The purpose of this anatomic study was to investigate the precision of estimating normal scaphoid lengths based on intact adjacent bone dimensions, compared with using the contralateral scaphoid length. METHODS From bilateral computed tomographic scans of 28 healthy wrist pairs, 3-dimensional virtual bone models were created. The left and right scaphoid lengths were determined at the central axis. The capitate length at the central axis and the distal radius width served to derive an ipsilateral scaphoid length estimate. Estimation precision for individual cases was based on the 95% range (±1.96 × SD) of the observed differences between the actual and estimated lengths. RESULTS On average, the capitate length was 10% smaller than the scaphoid length; the radius width was 9% larger. Consequently, we averaged the capitate length and radius width for ipsilateral estimations. The average difference between the scaphoid length and the latter ipsilateral estimate was 0.1 mm. The average contralateral scaphoid length difference was also 0.1 mm. Estimation precisions, however, were ±2.2 and ±1.4 mm, respectively. CONCLUSIONS Scaphoid length estimation based on the contralateral scaphoid is more precise than the estimating scaphoid length using the ipsilateral radius and capitate. CLINICAL RELEVANCE Scaphoid overexpansion can be ensured if the restored length is at least 1.4 mm longer than the contralateral length. This may be valuable information when establishing a target length for reconstruction and investigating the consequences of scaphoid overexpansion on clinical function, such as range of motion, which are currently unknown.
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Methodology for Morphometric Analysis of Modern Human Contralateral Premolars. J Comput Assist Tomogr 2016; 40:617-25. [DOI: 10.1097/rct.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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