Effect of Screw Length and Geometry on Interfragmentary Compression in a Simulated Proximal Pole Scaphoid Fracture Model

Patel, Samik; Giugale, Juan M.; Debski, Richard E.; Fowler, John R.

doi:10.1177/1558944718795281

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…Furthermore, Patel et al showed no difference in compression between screws despite expecting greater compression with larger screw pitch. 25 Although the threaded nail has a larger screw pitch compared with the partially threaded or fully threaded screws, our study demonstrated that it provided the least amount of compression.…”

Section: Discussionmentioning

confidence: 59%

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

et al. 2022

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Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.

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Section: Discussionmentioning

confidence: 59%

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

et al. 2022

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“…When fixing scaphoid fractures with a screw, surgeons usually aim for a centre pathway with the tip reaching as far as the opposite pole. Some authors claim that perpendicular placement to the fracture is most important, while others emphasise screw length [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

“…A biomechanical study by Patel et al [40] indicated that in a proximal fracture, a longer non-perpendicular screw provided more compression than a shorter perpendicular screw. In our study, vBMD values were higher at the two poles and the subchondral region to the capitate than in the centre of the scaphoid.…”

Section: Discussionmentioning

confidence: 99%

3D computational anatomy of the scaphoid and its waist for use in fracture treatment

et al. 2021

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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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“…Maximizing screw length provides greater resistance to bending and rotational forces and greater bony purchase for stability. 10 Here we describe a technique of percutaneous dual antegrade screw fixation for proximal phalanx fractures with minimal violation of the extensor mechanism which facilitates immediate postoperative range of motion without splinting, utilizing only a soft dressing and buddy strapping.…”

mentioning

confidence: 99%

“…Screw convergence provides resistance to shortening and screws of similar length more widely distribute implant loads. Maximizing screw length provides greater resistance to bending and rotational forces and greater bony purchase for stability 10…”

mentioning

confidence: 99%

Double Barrel Screw Fixation for Proximal Phalanx Fracture

Gray

Rubio²,

Heifner³

et al. 2022

Techniques in Hand &Amp; Upper Extremity Surgery

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A variety of fixation options exist for treatment of unstable proximal phalanx fractures. Variables which require consideration include the strength of fixation, the invasiveness of the technique and the postoperative rehabilitation protocol. Here we present a minimally invasive technique for dual headless compression screw fixation of proximal phalanx fractures which reduces extensor tendon violation and allows early motion in the immediate postoperative period.

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Effect of Screw Length and Geometry on Interfragmentary Compression in a Simulated Proximal Pole Scaphoid Fracture Model

Cited by 4 publications

References 22 publications

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

3D computational anatomy of the scaphoid and its waist for use in fracture treatment

Double Barrel Screw Fixation for Proximal Phalanx Fracture

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