Abstract
PurposeThe purpose of this study was to simulate and calculate the probability of iatrogenic perforation of the scaphoid cortical bone when internal fixation appeared to be safe on radiographs. The results will assist surgeons in determining proper screw placement.MethodsThirty scaphoids were reconstructed using computed tomography data and image-processing software. Different central axes were determined by the software to simulate the surgical views. The safe zone (SZ) and risk zone (RZ) were identified on the axial projection radiographs by comparing the scaphoid bone stenosis measured by the fluoroscopic radiographs with a three-dimensional reconstruction of the scaphoid stenosis. Each original axial projection radiograph was zoomed and compiled to match a calculated average image. The RZ, SZ, and probability of perforations in various quadrants were calculated.ResultsUsing a volar view (approach), the mean risks of cortical perforation were 25% with screws and 36% with k-wires. Using a dorsal view (approach), the mean risks of cortical perforation were 18% with screws and 30% with k-wires. A high risk of perforation was detected at the ulnar–dorsal zone.ConclusionSurgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, particularly in the ulnar–dorsal and radial–dorsal quadrants, because such screws are likely to perforate the cortex. The position of the internal fixator should be assessed using a diagram outlining the various SZs. Therapeutic, Level III.
Highlights
Scaphoid fractures account for 10% of all hand fractures[1] and almost 60% of all carpal fractures[2]
A high risk of perforation was detected at the ulnar–dorsal zone
Surgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, in the ulnar–dorsal and radial–dorsal quadrants, because such screws are likely to perforate the cortex
Summary
Scaphoid fractures account for 10% of all hand fractures[1] and almost 60% of all carpal fractures[2]. The rate of misdiagnosis of scaphoid fractures is as high as 30% with conventional radiography[3]. Because internal fixation provides reasonable results, both patients and surgeons are willing to use intraosseous screw fixation to treat minimally and acutely displaced scaphoid fractures[4]. The goal of such treatment in young adults is to prevent carpal collapse and degenerative arthritis. The aim of stable fixation of a scaphoid fracture is to minimize the risk of non-union and osteonecrosis. Quality of the fixation determines the prognosis of patients with a scaphoid fracture
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