Shai Luria1, Yonatan Schwarcz2, Ronit Wollstein2, Patrick Emelife2, Gershon Zinger2, Eran Peleg2. 1. Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: shail@hadassah.org.il. 2. Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract
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.
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.
Authors: David J Slutsky; Guillaume Herzberg; Alexander Y Shin; Geert A Buijze; David C Ring; Chaitanya S Mudgal; Yuen-Fai Leung; Christian Dumontier Journal: J Wrist Surg Date: 2016-07-11
Authors: Dominik Gruszka; Robert Herr; Hans Hely; Peer Hofmann; Daniela Klitscher; Alexander Hofmann; Pol Maria Rommens Journal: PLoS One Date: 2016-01-07 Impact factor: 3.240