Scaphoid fractures are commonly treated with a single headless screw. There are different recommendations regarding the optimal location of this screw. The purpose of this study was to compare the location of screws placed for the treatment of acute scaphoid fractures with theoretical and virtual screw locations. 10 patients with acute scaphoid fractures treated surgically and with available pre- and postoperative CT scans were included. The scans were analysed using a 3D software model (Amira Dev 5.3, Mercury Computer Systems, Chelmsford, MA). On the preoperative CTs the displaced fractures were virtually reduced. Possible screw locations for fracture fixation were examined including one along the central third of the proximal fragment (central base screw), the scaphoid longitudinal axis calculated mathematically (PCA screw) and a screw placed perpendicular to the fracture plane (90 degree screw). The angle between the axes and fracture plains were measured. The angle and distance between the actual screw on the postoperative CT and the different virtual screw locations were measured as well.Introduction
Materials and Methods
Knowing the morphology of any fracture, including scaphoid fractures, is important in order to determine the fracture stability and the appropriate fixation technique. Scaphoid fractures are classified according to their radiographic appearance, and simple transverse waist fractures are considered the most common. There is no description in the literature of the 3-dimensional morphology of scaphoid fractures. Our hypothesis was that most scaphoid fractures are not perpendicular to its long axis, i.e. they are not simple transverse fractures. A 3-dimensional analysis was performed of CT scans of acute scaphoid fractures, conducted at two medical centres during a period of 6 years. A total of 124 scans were analysed (Amira Dev 5.3, Visage Imaging Inc). Thirty of the fractures were displaced and virtually reduced. Anatomical landmarks were marked on the distal radius articular surface in order to orient the scaphoid in the wrist. Shape analysis of the scaphoids and a calculation of the best fitted planes to the fractures were carried out implementing principal component analysis. The angles between the scaphoid's first principal axis to the fracture plane, articular plane and to the palmar-dorsal direction were measured. The fractures were analysed both for location (proximal, waist and distal) and for displacement.Purpose
Methods
The surgical treatment of scaphoid fractures consists of reduction of the fracture followed by stable internal fixation using a headless compression screw. Proper positioning of the screw remains technically challenging and therefore computer assisted surgery may have an advantage. Navigation assisted surgery requires placement and registration of stable reference markers which is technically impossible in a small bone like the scaphoid. Custom made wrist-positioning devices with built-in reference markers have been developed for this purpose. The purpose of this study was to evaluate a different method of navigation assisted scaphoid fracture fixation. Temporary stabilisation with a pin of the scaphoid to the radius enables placement of the reference markers on the radius. Our hypothesis was that this method will achieve precise fracture fixation, superior to the standard free hand technique. In 20 identical saw bone models with mobile scaphoids, the scaphoid was stabilised to the radius using one Kirschner wire (KW). An additional KW representing the fixating screw was placed either using the Mazor Renaissance Robotic System (MAZOR Surgical Technologies, Israel) or standard free hand technique. CT scans were performed prior to fixation and after fixation in order to plan the location of the KW and compare this planned location with the final result.Purpose
Methods
Knowing the morphology of any fracture, including scaphoid fractures, is important in order to determine the fracture stability and the appropriate fixation technique. Scaphoid fractures are classified according to their radiographic appearance, and simple transverse waist fractures are considered the most common. There is no description in the literature of the 3-dimensional morphology of scaphoid fractures. Our hypothesis was that most scaphoid fractures are not perpendicular to its long axis, i.e. they are not simple transverse fractures. A 3-dimensional analysis was performed of CT scans of acute scaphoid fractures, conducted at two medical centers during a period of 6 years. A total of 124 scans were analysed (Amira Dev 5.3, Visage Imaging Inc). Thirty of the fractures were displaced and virtually reduced. Anatomical landmarks were marked on the distal radius articular surface in order to orient the scaphoid in the wrist. Shape analysis of the scaphoids and a calculation of the best fitted planes to the fractures were carried out implementing principal component analysis. The angles between the scaphoid's first principal axis to the fracture plane, articular plane and to the palmar-dorsal direction were measured. The fractures were analysed both for location (proximal, waist and distal) and for displacement.Purpose
Methods
The fractures in need of reduction and fixation of the plateau fracture involve raising the depressed articular fragment, the possible addition of bone graft augmentation and buttressing of the osteochondral fragment with a plate. These buttress plates may hold the cortical rim of the plateau but many times fail in maintaining the reduction of the intra-articular surface of the plateau. This again results in degenerative changes in the joint and pain. Internal fixation of these fractures with small fragment plates may be a solution to this problem, as demonstrated by the 5 presented cases treated operatively. The plates are smaller in size and are held by more screws, which are more proximal to the articular surface. This way they allow better control and maintenance of the anatomic reduction and in combination with an a-traumatic dissection and less stress shielding effect, result in a low rate of local complications.
