Comparison of Percutaneous Dorsal Versus Volar Fixation of Scaphoid Waist Fractures Using a Computer Model in Cadavers

Soubeyrand, Marc; Biau, David; Mansour, C.; Mahjoub, Sabri; Molina, Véronique; Gagey, Olivier

doi:10.1016/j.jhsa.2009.07.012

Cited by 40 publications

(35 citation statements)

References 34 publications

(30 reference statements)

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“…The above facts justify our choice of the palmar percutaneous and dorsal limited approaches for the surgical treatment of nondislocated or minimally dislocated scaphoid waist fractures. Soubeyrand et al 26 demonstrated the suitability of both approaches for the treatment of B2 type fractures of the scaphoid using a computer model in cadavers.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study

Dráč¹,

Čižmář²,

Manák³

et al. 2014

BIOMED PAP

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Aims.To compare the functional results and complications associated with palmar percutaneous and dorsal limited approaches in the surgical treatment of nondisplaced or minimally displaced scaphoid fractures type B2. Methods. A total of 76 patients with acute nondisplaced or minimally displaced type B2 scaphoid fractures were included in a prospective randomised study. The assignment patients to groups according to type of operative approach was based on systematic sampling. Clinical follow-up, X-ray or CT imaging were performed at four, eight and twelve weeks and one year after the surgery. Patient satisfaction and the results of DASH form were evaluated as well. The differences were statistically tested. Results. We found significantly better flexion and grip strength in the group of palmar percutaneous aprroach during the follow-up examination at eight weeks after the surgery. Significantly better flexion of the same group persisted at twelve-week follow-up examination. No differences in results or complications were statistically significant up to one year follow up. Conclusions. We found no advantage to the palmar percutaneous approach in the treatment of nondisplaced and minimally displaced scaphoid fractures type B2 compared to dorsal limited approach.

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Section: Discussionmentioning

confidence: 99%

Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study

Dráč¹,

Čižmář²,

Manák³

et al. 2014

BIOMED PAP

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“…Our study showed it is impossible to insert a screw guidewire contained completely within the distal pole of the central zone to the proximal pole of the central zone due to the very narrow and irregular curvature of the central zone. In fact, the fracture line may run transversely, horizontally or vertically from the waist portion to the distal or proximal third of the scaphoid [1,12,16,17]. When the fracture line runs in the proximal half, screw-axis placement in the proximal central zone should undoubtedly be considered central; however, when the fracture line runs distally, the question becomes: Should the screw axis in the proximal central zone be considered central or not?…”

Section: Discussionmentioning

confidence: 99%

Establishing a central zone in scaphoid surgery: a computational approach

Guo

Tian

Chen

et al. 2013

International Orthopaedics (SICOT)

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Purpose Scaphoid fractures are commonly fixed with headless cannulated screws positioned centrally in the scaphoid. Judgement of central placement of the screw may be difficult. We generated a central zone using computer analysis of 3D reconstructions of computed tomography (CT) images. As long as the screw axis is completely contained within this central zone, the screw would be considered as centrally placed. Methods Thirty cases of 3D CT reconstructions of normal scaphoids in a computerised operation planning and simulation system (Vxwork software) were obtained. The central zone was established after some distance shrinkage of the original scaphoid surface reconstruction model using the function "erode" in the software. The shape of the central zone was evaluated, and the width of the central zone in the proximal pole, waist portion and distal pole was measured. We also established the long axis of the scaphoid to see whether it stays in the central zone. Results All central zones could be divided into distal, waist and proximal portions according to the corresponding irregular shape of the scaphoid. As the geometry of the central zone was so irregular and its width very narrow, it was possible to completely contain the screw axis either in the proximal portion alone, waist alone or distal central zone alone. Conclusions Establishing the central zone of scaphoid 3D CT images provided a baseline for discussion of central placement of a scaphoid screw. The geometry of the scaphoid central zone determined that the screw could hardly be inserted through entire scaphoid central area during surgery.

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“…The location and type of fracture determine which approach allows the best screw placement [18,37]. In nondisplaced waist fractures perpendicular to the long axis of the scaphoid, the approach depends on the surgeon's preference.…”

Section: Discussionmentioning

confidence: 99%

Influence of Screw Design, Sex, and Approach in Scaphoid Fracture Fixation

Meermans¹,

Verstreken²

2012

Clinical Orthopaedics &Amp; Related Research

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Background Screw fixation of scaphoid fractures has gained popularity. A long central screw has been shown to be biomechanically advantageous. Questions/purposes We compared the ability of different screw designs to obtain this goal and determined the influence of sex and approach on screw length. Methods We performed all measurements on threedimensional reconstructions of 20 CT scans of normal scaphoids (10 men and 10 women) with the use of software. The three-dimensional computer models were analyzed, the central axis was defined, and the screws were placed along this axis. We compared 15 different available screw designs and volar and dorsal screw placement. Results The length of the scaphoid along its central axis was longer in men (mean, 27.14 mm; standard error of the mean, 0.97 mm) than in women (mean, 23.86 mm; standard error of the mean, 0.37 mm). The screw length that can be used was longer in the volar approach (mean, 23.72 mm; standard error of the mean, 0.19 mm) than in the dorsal approach (mean, 23.31 mm; standard error of the mean, 0.19 mm) regardless of the screw design. Screws with a trailing thread diameter greater than 3.9 mm and leading thread diameter greater than 3.0 mm were shorter. Conclusions Scaphoids in women are smaller than in men. Theoretically, fixation of scaphoid fractures through a volar approach will allow the surgeon to use longer screws. The screw design has a significant influence on the screw length that can be used in scaphoid fracture fixation. We recommend using a differential pitch screw with a thread diameter of 3.9 mm or less.

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Comparison of Percutaneous Dorsal Versus Volar Fixation of Scaphoid Waist Fractures Using a Computer Model in Cadavers

Cited by 40 publications

References 34 publications

Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study

Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study

Establishing a central zone in scaphoid surgery: a computational approach

Influence of Screw Design, Sex, and Approach in Scaphoid Fracture Fixation

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