Computer-Assisted Percutaneous Scaphoid Fixation: Concepts and Evolution

Autor: Erin Janine Smith, David R. Pichora, Randy E. Ellis
Rok vydání: 2013
Předmět:
Zdroj: Journal of Wrist Surgery. :299-305
ISSN: 2163-3924
2163-3916
Popis: Nondisplaced scaphoid waist fractures are typically treated with a long- or short-arm thumb spica cast for ∼8–12 weeks until fracture union is observed.1 This treatment is effective in excess of 90%.2 Displaced waist fractures, unstable fractures, and proximal pole fractures have a much higher risk of nonunion,2 and for this reason, many surgeons elect to treat these fractures surgically with internal fixation. Percutaneous scaphoid fixation was first reported in 1970 by Streli3 and has since evolved to be a standard technique for internal scaphoid fixation. Several studies have reported excellent clinical results with the percutaneous approach4 5 6 and improved outcomes in comparison to cast immobilization7 8 and open fixation.9 Performing the procedure percutaneously, however, is associated with its own risks and challenges. The scaphoid has a complex, twisted, highly variable three-dimensional shape.10 As a result, fixation using standard two-dimensional fluoroscopy can be cumbersome. The standard technique requires a high reliance on X-ray use, which poses a radiation exposure risk to both the patient and the surgical team.11 12 The mechanical stability and clinical outcome of the procedure have been linked to maximizing the central placement of the fixation screw along the scaphoid axis,13 14 15 demanding good accuracy of guidewire placement and the avoidance of screw breaches.14 An alternative may be to use computer-assisted surgical techniques to solve the problems associated with percutaneous scaphoid fixation. Computer-assisted surgery utilizes computer technology for preoperative planning and intraoperative guidance of surgical interventions. Initially developed for use in neurosurgery,16 this technology has become prominent in several orthopaedic applications including spine pedicle screw insertion,17 orthopedic hip arthroplasty,18 pelvic osteotomy,19 total knee arthroplasty,20 high tibial osteotomy,21 and distal radius osteotomy.22 Computer-assisted techniques have demonstrated a reduced radiation exposure and improved accuracy in many of these procedures. Although computer-assisted technology is attractive for scaphoid fixation, the conventional workflow for computer-assisted orthopedic surgery does not translate readily to scaphoid fractures. This article aims to educate the reader about the general principles of computer-assisted orthopedic surgery and the evolution of these techniques for scaphoid fixation. The current progress of five groups implementing such systems is also reviewed and compared.
Databáze: OpenAIRE
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