In Reply

Abstract

The aim of this cadaver study was not to describe a solution for the majority of “transverse” waist fractures. According to the literature, these may be the most common fractures, but the tools used for the classification in the past are inaccurate compared with the tools we are using today.1Guo Y. Tian G.L. The length and position of the long axis of the scaphoid measured by analysis of three-dimensional reconstructions of computed tomography images.J Hand Surg. 2011; 36B: 98-101Google Scholar, 2Leventhal E.L. Wolfe S.W. Walsh E.F. Crisco J.J. A computational approach to the “optimal” screw axis location and orientation in the scaphoid bone.J Hand Surg. 2009; 34A: 677-684Google Scholar, 3Murase T. Moritomo H. Goto A. Sugamoto K. Yoshikawa H. Does three-dimensional computer simulation improve results of scaphoid nonunion surgery?.Clin Orthop Relat Res. 2005; 434: 143-150Crossref PubMed Scopus (30) Google Scholar Analysis of fractures with radiographs without a clear definition of the long axis of the scaphoid questions the use of the word “transverse.”4Compson J.P. The anatomy of acute scaphoid fractures: a three-dimensional analysis of patterns.J Bone Joint Surg. 1998; 80B: 218-224Crossref Scopus (66) Google Scholar The short oblique simulation of a fracture may not be as rare as suggested. These may be the fractures that more readily displace and that truly need stable fixation.Nevertheless, the real purpose of this study was to examine the concept of a screw perpendicular to the scaphoid fracture. For this reason, we needed an unstable fracture. It was a great chance to perform the fixation without passing through the scaphotrapezial joint, which would make the percutaneous technique easier. If this unstable fracture may be fixed perpendicular to the fracture, any fracture can.Regarding the scaphotrapezial joint, we agree that approaching the scaphoid through this joint has not been found to be a major problem. We believe that if we can achieve the same stability of fixation without going through the joint, in a method that is technically easier, this could only be an advantage. This is especially true with a volar percutaneous approach. The aim of this cadaver study was not to describe a solution for the majority of “transverse” waist fractures. According to the literature, these may be the most common fractures, but the tools used for the classification in the past are inaccurate compared with the tools we are using today.1Guo Y. Tian G.L. The length and position of the long axis of the scaphoid measured by analysis of three-dimensional reconstructions of computed tomography images.J Hand Surg. 2011; 36B: 98-101Google Scholar, 2Leventhal E.L. Wolfe S.W. Walsh E.F. Crisco J.J. A computational approach to the “optimal” screw axis location and orientation in the scaphoid bone.J Hand Surg. 2009; 34A: 677-684Google Scholar, 3Murase T. Moritomo H. Goto A. Sugamoto K. Yoshikawa H. Does three-dimensional computer simulation improve results of scaphoid nonunion surgery?.Clin Orthop Relat Res. 2005; 434: 143-150Crossref PubMed Scopus (30) Google Scholar Analysis of fractures with radiographs without a clear definition of the long axis of the scaphoid questions the use of the word “transverse.”4Compson J.P. The anatomy of acute scaphoid fractures: a three-dimensional analysis of patterns.J Bone Joint Surg. 1998; 80B: 218-224Crossref Scopus (66) Google Scholar The short oblique simulation of a fracture may not be as rare as suggested. These may be the fractures that more readily displace and that truly need stable fixation. Nevertheless, the real purpose of this study was to examine the concept of a screw perpendicular to the scaphoid fracture. For this reason, we needed an unstable fracture. It was a great chance to perform the fixation without passing through the scaphotrapezial joint, which would make the percutaneous technique easier. If this unstable fracture may be fixed perpendicular to the fracture, any fracture can. Regarding the scaphotrapezial joint, we agree that approaching the scaphoid through this joint has not been found to be a major problem. We believe that if we can achieve the same stability of fixation without going through the joint, in a method that is technically easier, this could only be an advantage. This is especially true with a volar percutaneous approach. Letter Regarding “Optimal Fixation of Oblique Scaphoid Fractures: A Cadaver Model”Journal of Hand SurgeryVol. 37Issue 9PreviewWe read with interest the article by Luria et al, “Optimal fixation of oblique scaphoid fractures: a cadaver model.”1 The authors compared the stability of a screw placed perpendicular to the fracture plane in scaphoid fractures with a screw placed in the center of the proximal fragment. Biomechanical testing demonstrated no significant difference in the load to failure. They concluded that a screw placed through the tuberosity and perpendicular to the fracture plane results in similar stability and has the advantage of avoiding the scaphotrapezial joint. Full-Text PDF