Abstract
BackgroundA detailed understanding of scaphoid anatomy helps anatomic fracture reduction, and optimal screw position. Therefore, we analysed (1) the size and shape variations of the cartilage and osseous surface, (2) the distribution of volumetric bone mineral density (vBMD) and (3) if the vBMD values differ between a peripheral and a central screw pathway?MethodsForty-three fresh frozen hand specimens (17 females, 26 males) were analysed with high-resolution peripheral quantitative computed tomography (HR-pQCT) and dissected to compute a 3D-statistical osseous and cartilage surface model and a 3D-averaged vBMD model of the scaphoid. 3D patterns were analysed using principal component analysis (PCA). vBMD was analysed via averaging HR-pQCT grey values and virtual bone probing along a central and peripheral pathway.Results(1) PCA displayed most notable variation in length ranging from 1.7 cm (− 2SD) to 2.6 cm (mean) and 3.7 cm (+ 2SD) associated with differences of the width and configuration of the dorsal surface (curved and narrow (4 mm) to a wider width (9 mm)). (2) High vBMD was located in the peripheral zone. Lowest vBMD was observed in the centre and waist. (3) Virtual probing along a peripheral pathway near to the cartilage surfaces for the capitate and lunate allowed the center region to be bypassed, resulting in increased vBMD compared to a central pathway.ConclusionHigh anatomical variations regarding the osseous and cartilage surfaces were associated with three distinct concentrically arranged zones with notable different vBMD. The complex scaphoid anatomy with its waist might alter the strategy of fracture fixation, education and research.
Highlights
A detailed understanding of scaphoid anatomy helps anatomic fracture reduction, and optimal screw position
The complex scaphoid anatomy with its waist might alter the strategy of fracture fixation, education and research
We aimed to determine (1) the size and shape variations of the cartilaginous and osseous surface of the scaphoid, (2) the volumetric bone mineral density distribution and (3) if the vBMD values differ between a peripheral and a central screw pathway
Summary
A detailed understanding of scaphoid anatomy helps anatomic fracture reduction, and optimal screw position. We analysed (1) the size and shape variations of the cartilage and osseous surface, (2) the distribution of volumetric bone mineral density (vBMD) and (3) if the vBMD values differ between a peripheral and a central screw pathway?. Unstable and displaced fractures can be stabilised by intraosseous, centrally placed screw fixation or k-wires to achieve anatomic reduction and fracture fixation [4]. The technique and approach depend on several factors such as the fracture pattern, deformity and vascularity of the proximal pole [4]. Nonunion occurs in 5% to 25% of scaphoid fractures depending on different risk factors such as smoking, displacement over 1 mm or a vertical oblique fracture line [3]
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