Scaphoid alignment in dorsally displaced distal radial fracture: a radiographic study

The Three-Dimensional Relationship of the Axes of the Capitate and Third Metacarpal

PURPOSE

We quantified the morphology and angulation of the third metacarpal (MC3) relative to the capitate using three-dimensional computed tomography data to inform surgical procedures such as total wrist arthroplasty and wrist arthrodesis. Specifically, we report the three-dimensional location of the intersections of the long axis of MC3 axis with the capitate cortical surface, the sagittal and coronal angles between the MC3 and capitate axes, and the MC3 shaft angle in the sagittal plane. We tested the hypothesis that these metrics did not differ between women and men.

METHODS

Three-dimensional bone models of the capitate and MC3 were analyzed in 130 subjects (61M and 69F). Long axes of the MC3 and capitate were computed. The intersection of the metacarpal long axis with the cortical surface of the capitate, the angle between the metacarpal-capitate axes, and metacarpal shaft angle were calculated and compared between men and women.

RESULTS

The long axis of the MC3 intersected the capitate at two locations on the outer cortical surface of the capitate. The proximal intersection was located near the midportion of the capitate, whereas the distal intersection was typically located within the capitate-MC3 articulation. The angle between the axes of the capitate and MC3 in the sagittal plane was a mean of 15°, ranging from 5° to 23°. The mean sagittal MC3 shaft angle was 166° and ranged from 158° to 173°.There were only subtle differences in these metrics between the sexes.

CONCLUSIONS

The long axis of the MC3 penetrates the dorsal surface of the capitate about its midportion, but there is notable variation in this location as well as in the angular relationships.

CLINICAL RELEVANCE

Three-dimensional measurements of the relationships between the third metacarpal and the capitate may serve as an important reference for the placement of intramedullary wires, plates, devices, and prosthetics.

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Background

The aim of this prospective study was to assess the incidence of complex regional pain syndrome type I (CRPS I) in patients with scaphoid waist fracture and to explore associated factors.

Methods

This was a multicenter, prospective observational study. Demographic, imaging indicators and clinical data were collected before the conservative treatment of scaphoid waist fracture patients. The occurrence of CRPS I and pain condition were the main outcomes. To explore the factors associated with CRPS I, multivariate logistic regression model was used.

Results

A total of 493 scaphoid waist fracture participants undergoing conservative treatment were recruited for this study. The incidence of CRPS I was 20% (n = 87). The average time between injury and the onset of CRPS I was 6.7 ± 2.1 weeks. Multivariable logistic regression analysis revealed that female sex (odds ratio (OR): 1.669; 95% confidence interval (CI): 1.189–2.338), diabetes mellitus (OR: 3.206; 95% CI: 2.284–4.492), and severe pain condition before treatment (visual analog scale (VAS) score more than 4 cm) (OR: 27.966; 95% CI: 19.924–39.187) were independently associated with CRPS I.

Conclusions

Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. Early screening and regular follow up evaluation are recommended in these patients.