Scaphoid screw placement under minimal radiation exposure

BACKGROUND

Percutaneous scaphoid fixation through either a volar or dorsal approach has the advantage of minor soft tissue damage compared with ORIF, and faster fracture union compared with conservative treatment. However, this technique demands highly intraoperative reliance on X-ray control, including increased radiation exposure and all associated side effects.

PURPOSE

To test the possibility and efficacy of volar percutaneous scaphoid screw placement under minimalradiation exposure.

METHODS

The sample included 20 hands (seven left, 13 right) from human adult cadavers. For this study, the utilised wrists were assumed to have non-displaced scaphoid fractures. Using a percutaneous approach, a 2-mm Kirschner wire (K-wire) was advanced to the distal pole of the scaphoid and placed in a 45° horizontal and vertical angle under monitoring with the C-arm. The K-wire was inserted blindly alongside the estimated length of the scaphoid. Following K-wire insertion, four X-rays were taken to depict K-wire positioning and to assess positioning alongside the axis of the scaphoid and K-wire protrusion. The rating scale comprised 1 (good), 2 (moderate) or 3 (poor).

RESULTS

All tested radiographic views were evaluated with a median of 2 points (moderate position) regardingplacement alongside the scaphoid axis.

CONCLUSION

Our results indicate that percutaneous scaphoid fixation with the guide wire placed in a 45° horizontal and vertical angle enables primary moderate positioning, which may lead to quicker adjustment to the ideal position and a decrease of radiation exposure.

Carpal and scaphoid fracture incidence in south-eastern Australia: an epidemiologic study

Carpal fractures were identified by the Geelong Osteoporosis Study Fracture Grid for 2006-2007. Incidence rates were higher in males than females. Males had a lower median age of fracture than females. Females had more fractures on the left side than males. Most fractures were the result of a fall.

PURPOSE

In this study, we report the incidence of carpal bone fractures (scaphoid and non-scaphoid) amongst residents from the Barwon Statistical Division over 2 years.

METHODS

X-ray reports from imaging centres in the region were used to identify incident fractures during 2006 and 2007. Data were collected as part of the Geelong Osteoporosis Study Fracture Grid.

RESULTS

During 2006 and 2007, there were 171 and 41 carpal fractures in males and females, respectively. Of these, 131 males and 29 females had fractured the scaphoid bone. Females had a higher proportion of left-sided fractures (>70 %) than males (∼40 %). Most fractures were the result of an accidental fall (>87 %). Patterns of incidence for males showed one major peak around 20-29 years. For females, peaks occurred around age 10-19 years and 70-79 years. Incidence rates for males (per 100,000 persons per year) were 54.6 (95 % confidence interval (CI) 53.6, 55.7) and 15.9 (95 % CI 15.4, 16.5) for scaphoid and non-scaphoid fractures, respectively. In females, the corresponding rates were 10.6 (95 % CI 10.2, 11.1) and 4.5 (95 % CI 4.2, 4.8).

CONCLUSION

Almost all fractures were the result of a fall. In males, carpal fractures were sustained mainly during early adulthood and in females during adolescence and after menopause. Incidence rates for males were higher than those in females for both scaphoid and non-scaphoid fractures.

Early CT for suspected occult scaphoid fractures

In this study, the use of computed tomography (CT) early in the management of suspected occult scaphoid fractures was evaluated. We retrospectively reviewed the notes and radiology of patients who had scaphoid CT scans over the preceding 3 years. Eighty-four patients that had CT scans within 14 days from injury were identified. Of the CT scans, 64% (n = 54) excluded a fracture and these patients were promptly mobilized. No patients returned with any complications from this management. Overall, 36% of CT scans were abnormal (n = 30), 7% revealed occult scaphoid fractures, 18% revealed occult carpal fractures of the triquetrum, capitate, and lunate, respectively, and 5% revealed distal radius fractures. All patients diagnosed with fractures were successfully managed with plaster immobilization and there was one case of complex regional pain syndrome. Early CT alters therapeutic decision making in suspected occult fractures preventing unnecessary immobilization in a working population without increase in cost.