Approach to the Perpendicular Fixation of a Scaphoid Waist Fracture-A Computer Analyzed Cadaver Model
| Autor: | Thanapong Waitayawinyu, Shai Luria, Eran Peleg, Yonatan Schwarcz, Samih Badir |
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| Rok vydání: | 2018 |
| Předmět: |
musculoskeletal diseases
Waist Scaphoid fracture 030230 surgery Wrist 03 medical and health sciences Fixation (surgical) Fracture Fixation Internal Fractures Bone 0302 clinical medicine Cadaver medicine Perpendicular Humans Orthopedics and Sports Medicine Orthodontics Scaphoid Bone 030222 orthopedics business.industry Computers Oblique case musculoskeletal system medicine.disease Transverse plane medicine.anatomical_structure Surgery business |
| Zdroj: | The Journal of hand surgery. 45(3) |
| ISSN: | 1531-6564 |
| Popis: | Purpose In scaphoid fracture screw fixation, the screw is commonly placed along the long axis of the bone, without consideration of the fracture plane. This position is not perpendicular to transverse waist fractures or to the more common horizontal oblique fractures. Our aim was to examine the feasibility and describe possible approaches to, placing a screw perpendicular and in the center of the scaphoid waist fracture. Methods Computed tomography of 12 cadaver wrists was performed in 3 positions to examine possible approaches in flexion, neutral, and extension of the wrist. The scans were evaluated using a 3-dimensional model that simulated horizontal oblique (60°) and transverse (90°) fractures. We examined all possible approaches for screw positioning and their deviation from the axis perpendicular to the fracture and in the center of its plane. Results The preferred approaches for a perpendicular screw in a horizontal oblique fracture were found to be proximal-dorsal in flexion or transtrapezial in the extended or neutral positions (through the volar-radial trapezium). In transverse fractures, the possible approaches were proximal-dorsal or transtrapezial in the flexed or neutral positions and distal in the extended position (volar to volar-radial trapezium). In these approaches, the screw could be placed perpendicularly (deviating by Conclusions According to this model, it appears feasible to place a perpendicular screw in the center of a horizontal oblique waist fracture using a proximal-dorsal approach in flexion or a transtrapezial approach in neutral or extension positions of the wrist. Palpable landmarks may be used as additional guides to direct these approaches according to the clinical setting. Clinical relevance Perpendicular screw fixation of horizontal oblique or transverse scaphoid waist fractures is a possible option, if chosen for its biomechanical advantages. |
| Databáze: | OpenAIRE |
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