Purpose Scaphoid fractures are classified according to their 2-dimensional radiographic appearance, and transverse waist fractures are considered the most common. Our hypothesis was that most scaphoid fractures are not perpendicular to the longitudinal axis of the scaphoid (ie, not transverse). Methods Computerized 3-dimensional analyses were performed on 124 computed tomography scans of acute scaphoid fractures. Thirty of the fractures were displaced and virtually reduced. The angle between the scaphoid's first principal axis (longitudinal axis) and the fracture plane was analyzed for location and displacement. The distal radius articular surface was used to depict the volar–dorsal vector of the wrist. Results There were 86 fractures of the waist, 13 of the distal third, and 25 of the proximal third. The average angle between the scaphoid longitudinal axis and the fracture plane was 53° for all fractures and 56° for waist fractures, both differing significantly from a 90°, transverse fracture. The majority of fracture planes were found to have a volar distal to dorsal proximal (horizontal oblique) inclination relative to the volar–dorsal vector. Conclusions Most waist fractures were horizontal oblique and not transverse. According to these findings, fixation of all fractures along the longitudinal axis of the scaphoid may not be the optimal mode of fixation for most. A different approach may be needed in accordance with the fracture plane. Type of study/level of evidence Diagnostic II.

3-dimensional analysis of scaphoid fracture angle morphology.

Abstract Purpose The purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method. Methods This retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups. Results The average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower ( P &lt; 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter ( P &lt; 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher ( P &lt; 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time. Conclusion Robot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture. 

https://link.springer.com/content/pdf/10.1007/s00264-022-05532-9.pdf

Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study

79 Copyright c 2016 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Address reprint requests to: Jin Rok Oh, M.D., Ph.D. Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: 82-33-741-1356ᆞFax: 82-33-746-7326 E-mail: jroh@yonsei.ac.kr Financial support: None. Conflict of interest: None. 주상골 골절 및 불유합

Scaphoid Fractures and Nonunion

Purpose To study the angle of screw placement in relation to the scaphoid fracture plane and its effect on union after percutaneous fixation of scaphoid waist fractures. Methods Twenty-four consecutive scaphoid waist fractures were retrospectively evaluated for the orientation of screws in relation to the fracture plane using a method in which the sum-of-smaller angles (SSA) in 3 different radiographs were used to correlate with time to fracture union. Results All but one patient achieved union after percutaneous fixation of the scaphoid. Another patient required revision surgery within the study period for inadequate fixation. A shortened time to union was significantly correlated to larger SSA. Conclusions SSA may be a reasonable predictor of union after percutaneous fixation of scaphoid waist fracture. It can be reliably calculated using plain radiographs. An SSA of 190° or more correlated with union by 8 weeks postoperatively. Type of study/level of evidence Prognostic IV.

/pdf/radiographic-parameters-to-predict-union-after-volar-10kbusi3ew.pdf

Radiographic Parameters to Predict Union After Volar Percutaneous Fixation of Herbert Type B1 and B2 Scaphoid Fractures.

Background Scaphoid fractures are most common in young active men. Undisplaced or minimally displaced scaphoid fractures can be treated either conservatively or operatively by percutaneous screw fixation (PSF) rather than by open surgery. Advantages of PSF are earlier mobilization and return to work with avoidance of complications of prolonged casting and open surgery. The concept of bone marrow injection in cases of delayed healing, nonunion, and poor bone healing is well accepted. Patients and methods Twenty-four patients with undisplaced or minimally displaced scaphoid fractures were treated within 3 weeks of sustaining the injury with PSF using headless cannulated Herbert screws through a volar approach. The fixation procedure was augmented by injection of autogenous bone marrow aspirated from the iliac bone. There were 19 male and five female patients with a mean age of 27.5 years (average 19-47 years). These patients were followed up for a mean period of 10 months (average 7-12 months). Results All fractures united at a mean of 7 weeks (average 6-10 weeks) and all patients returned to sedentary work within 1 week and to manual work within 8 weeks. At last follow-up, average wrist range of motion was extension of 60° (range 50-70) and flexion of 55° (range 50-60) and the percentage of range of wrist motion as compared with the contralateral side was between 85 and 95%, with a mean of 90%. No complications from either procedure were encountered. Conclusion PSF for nondisplaced and minimally displaced scaphoid fractures augmented with bone marrow injection resulted in fast radiographic union and early return to work. The procedure was performed as day-case surgery with no complications. We recommend the use of this procedure for scaphoid fractures with delayed union and certain types of nonunion.

Volar percutaneous screw fixation and autogenous bone marrow injection for acute scaphoid fractures

Background:The fluoroscopic imaging technique that has been used in the dorsal percutaneous screw fixation of scaphoid fracture was modified for more consistent central screw placement according to the different fracture locations.Methods:Eighteen scaphoids of the fresh-frozen cadaver were used. The

Modified Fluoroscopic Imaging Technique for the Central Screw Placement in Percutaneous Screw Fixation of Scaphoid Fracture

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Modified Fluoroscopic Imaging Technique for the Central Screw Placement in Percutaneous Screw Fixation of Scaphoid Fracture