Ideal Starting Point and Trajectory of a Screw for the Dorsal Approach to Scaphoid Fractures

Kupperman, Asher I.; Breighner, Ryan; Saltzman, Eliana B.; Sneag, Darryl B.; Wolfe, Scott W.

doi:10.1016/j.jhsa.2018.03.044

Cited by 12 publications

(7 citation statements)

References 21 publications

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“…Similarly, Kupperman et al posit that screw insertion perpendicular to the fracture is of importance. 15 This study is limited by the fact that only dorsal screw insertion was considered, proximal and distal pole as well as waist fractures were tested, and screw position was defined not as the location of the screw within the scaphoid, but rather as a starting point of insertion.…”

Section: Discussionmentioning

confidence: 99%

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Lucenti¹,

Lutsky

Jones

et al. 2019

Jnl Wrist Surg

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Background Scaphoid waist fractures are often treated using headless compression screws using dorsal or volar approaches. Objectives The purpose of this study is to compare differences in screw position using a volar (retrograde) or dorsal (antegrade) approach. Patients and Methods A total of 82 patients were retrospectively evaluated: 41 treated with a volar and 41 with a dorsal approach were selected. Postoperative radiographs were reviewed by three observers who rated screw location in the proximal pole, waist, and distal pole. Results Thirty-four patients (83%) in the antegrade group had central screw placement in the waist of the scaphoid in posteroanterior and lateral planes compared with 14 (34.9%) in the retrograde group (p < 0.05). For the antegrade group, the screw was central in 217 of 246 zones (88.2%) compared with 127 of 246 (51.6%) in the retrograde group (p < 0.05). Conclusions The dorsal antegrade approach appears to allow the surgeon to achieve central screw placement along all three scaphoid regions. Level of Evidence This is Level III study.

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Section: Discussionmentioning

confidence: 99%

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Lucenti¹,

Lutsky

Jones

et al. 2019

Jnl Wrist Surg

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“…Kupperman et al in 2018 and Faucher et al in 2015 showed that perpendicular fixation of scaphoid fractures allowed the use of shorter screws and better fracture compression. 21,22 Therefore, screw protrusion within the middle segments is of increasing relevance as we deviate from the standard starting point and central placement of screws in scaphoid fracture fixation. Several studies have also recommended radiographic evaluation of the scaphoid using the Billiard view, with the forearm 45 pronated and wrist ulnar deviated.…”

Section: Discussionmentioning

confidence: 99%

“…in 2018 and Faucher et al . in 2015 showed that perpendicular fixation of scaphoid fractures allowed the use of shorter screws and better fracture compression 21,22 . Therefore, screw protrusion within the middle segments is of increasing relevance as we deviate from the standard starting point and central placement of screws in scaphoid fracture fixation.…”

Section: Discussionmentioning

confidence: 99%

Determining the optimal radiologic wrist and forearm position to visualize screw protrusion in scaphoid fixation

Yong

Liu

Tee

et al. 2023

ANZ Journal of Surgery

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Background: Surgical fixation of scaphoid fractures may result in unrecognized screw protrusion and subsequent cartilage damage to the adjacent joints. The purpose of this study was to use a three-dimensional (3D) scaphoid model to determine the wrist and forearm positioning that will allow intra-operative fluoroscopic visualization of screw protrusions. Methods: Two 3D scaphoid models, with the wrist in neutral and 20 ulnar deviated, were reconstructed from a cadaveric wrist using the Mimics software. The scaphoid models were divided into three segments and further divided into four quadrants in each of the three segments along the scaphoid axes. Two virtual screws, with a 2 and 1 mm groove from the distal border, were placed so that the screws protrude from each quadrant. The wrist models were rotated along the long axis of the forearm and the angles at which the screw protrusions were visualized were recorded. Results: One-millimetre screw protrusions were visualized at a narrower range of forearm rotation angles compared to 2 mm screw protrusions. One-millimetre screw protrusions in the middle dorsal ulnar quadrant could not be detected. Visualization of the screw protrusion in each quadrant varied with forearm and wrist positioning. Conclusion: In this model, all screw protrusions, except 1 mm protrusions in the middle dorsal ulnar quadrant, were visualized with the forearm in pronation, supination or in the mid-pronation position and with the wrist in neutral or 20 ulnar deviated.

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“…First, the scaphoid’s longitudinal axis was defined manually, from the proximal to the distal pole of the scaphoid. There was no algorithm to help us calculate it, as there might have been in recent 3D studies (Kupperman et al., 2018; Leventhal et al., 2009; Luria et al., 2015; Ten Berg et al., 2018). This means that our results are not strictly comparable to other studies, since the longitudinal axes used may differ by a few degrees.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous fixation of scaphoid fractures through the snuffbox: an anatomical study

Nguyễn

Chaves

Crenn³

et al. 2023

J Hand Surg Eur Vol

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The aim of the present anatomical study was to assess the dorso-radial approach for percutaneous fixation of scaphoid wist fractures. Through the anatomical snuffbox, cannulated screws or 1.2 mm K-wires were inserted into the scaphoids of 20 fresh-frozen cadavers. No tendon injuries were observed. There were two lesions of the radial artery, and three lesions of the sensory branches of the radial nerve. After dissection and three-dimensional CT reconstruction, the K-wire or screw position was described in relation to the scaphoid centroid and its longitudinal axis. The mean distance between the device and the scaphoid centroid was 2.8 mm (SD 1.4, range 0.6 to 6.1). The mean angle between the device and the scaphoid’s longitudinal axis was 29° (SD 11, range 6.5 to 54). Rather than percutaneous fixation, an open approach with a modest incision might be safer for identifying and protecting both the radial artery and the sensory nerves. This approach would make perpendicular fixation possible for specific patterns of scaphoid fracture orientated approximately 60° from the longitudinal axis.

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Ideal Starting Point and Trajectory of a Screw for the Dorsal Approach to Scaphoid Fractures

Abstract: Screw starting point and trajectory for scaphoid fractures may be altered based on fracture type to obtain a long screw that is closer to perpendicular to the fracture.

Cited by 12 publications

References 21 publications

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Determining the optimal radiologic wrist and forearm position to visualize screw protrusion in scaphoid fixation

Percutaneous fixation of scaphoid fractures through the snuffbox: an anatomical study

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