Fixation Of Scaphoid Fractures Research Articles

Porous Mg–Hydroxyapatite Composite Incorporated with Aloe barbadensis Miller for Scaphoid Fracture Fixation: A Natural Drug Loaded Orthopedic Implant

The current study focused on developing a biodegradable implant composite material that could work in a multitude of applications. The fabricated composite showcases a porous matrix of Mg–hydroxyapatite developed through the spacer-holder technique. The composite was incorporated with a natural medicinal plant, i.e., Aloe barbadensis miller, commonly known as the Aloe vera plant. The final composite was enveloped under a thin layer of PLA to work as an encapsulated drug as well as a composite material for implant applications. Further, the mechanical and microstructural properties were analyzed along with corrosion analysis through the weight loss method and pH change. The experiments showed an improvement in the corrosion rate when tested under cell culture medium. The antibacterial rates were experimented with under different aloe vera concentrations against Gram-positive B. subtilis and Gram-negative E. coli, and finally, a minimum inhibitory value was formulated for further experimentations. Hemocompatibility and surface wettability tests were also performed, which revealed improved surface hydrophilicity with a reduced hemolysis rate. An in vitro cell viability analysis was performed against the MG63 osteoblast cell line to indicate the cytotoxicity and cytocompatibility of the samples. This research proposed a novel composite material that provides antibacterial and non-toxic properties and retains its strength under a physiological environment.

Flexor Pollicis Longus Rupture After Scaphoid Fracture Repair: A Case Report

Background: Flexor Pollicis Longus (FPL) tendon attritional rupture is a rare diagnosis. Reported causes include distal radius plates, SNAC wrist, steroid injection and CMC1 arthrodesis hardware. We describe an FPL rupture 1 year after scaphoid waist fracture fixation. Case description: A 23-year-old male ruptured his FPL when it abraded on a headless compression scaphoid screw. After full union of the fracture hardware was removed and the ruptured FPL tendon was reconstructed with a palmaris longus graft.

Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration

BackgroundArticular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard.Materials and methodsTen fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique).ResultsStandard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001).ConclusionsStandard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases.Level of Evidence Not applicable.

A comparative cadaveric study for percutaneous scaphoid fixation: robotic vs freehand.

To compare the robotic-assisted and the traditional freehand percutaneous scaphoid fixation in number of guidewire attempts, duration of fluoroscopy time, amount of radiation dose, and screw centrality. Twenty cadaveric specimens were randomized into either the robotic or freehand group. The scaphoids in both groups were fixed by either the same attending or resident from our hand surgery department. The operation duration, amount of radiation from intraoperative fluoroscopy, total fluoroscopy time, and the number of guidewire attempts were documented and compared. Postoperatively, all the specimens had a computed tomography (CT) scan performed, and the difference in the final position of the screw and the central axis of the scaphoid was examined. In the robotic group, all the guide wires were satisfactorily positioned within a single attempt, while the median number of attempts in the traditional freehand group was 18 (quaternion 14-65). This also meant that the surgeon in the robotic group experienced significantly lower radiation exposure dose and time as compared to the freehand group. There were no significant differences in the final screw position as compared to the central axis of the scaphoid in both groups. Although there was no difference in surgeon performance in the robotic group, the operative time for the attending was significantly lower as compared to the resident in the freehand group. Robotic-assisted surgery for scaphoid fracture fixation is superior to the traditional freehand method as it facilitates accurate screw placement with lower radiation exposure and fewer guide wire attempts.

Ultrasound-Based Registration for the Computer-Assisted Navigated Percutaneous Scaphoid Fixation.

An ultrasound (US)-based computer-assisted approach has the potential to improve the accuracy and precision of screw placement for the percutaneous fixation of scaphoid fractures and also reduce the radiation dose for patient and clinical staff. Therefore, a surgical plan based on preoperative diagnostic computed tomography (CT) is registered with intraoperative US images, enabling a navigated percutaneous fracture fixation. However, approaches published so far rely on semimanual methods for intraoperative registration and are limited by long computation times. To address these challenges, we propose the employment of deep learning-based methods for US segmentation and registration in order to achieve a fast and fully automated yet robust registration process. For validation of the proposed US-based approach, we first provide a comparison of methods for segmentation and registration, assess their contribution to the overall error throughout our pipeline, and, finally, evaluate navigated screw placement in an in vitro study on 3-D printed carpal phantoms. Successful screw placement has been achieved for all ten screws, with deviations from the planned axis of 1.0 ± 0.6 and 0.7 ± 0.3 mm at the distal and proximal pole, respectively. The complete automation and total duration of about 12 s also allow seamless integration of our approach into the surgical workflow.

A Cadaveric Feasibility Study of an Automatic Multi-Degrees of Freedom Surgical Robot for Percutaneous Scaphoid Guide Pin Insertion.

Background: Percutaneous fixation of scaphoid fractures need accurate guide pin insertion. The emergence of computer-assisted navigation and robotic surgery may provide a promising solution to this problem. Methods: This study presents the development of an automatic multi-degrees of freedom (DOF) surgical robot with computer-assisted navigation system, focusing on percutaneous scaphoid guide pin insertion. Using this device, along with a 3D fluoroscopy unit, we have conducted an experimental study on 10 cadavers for percutaneous scaphoid guide pin insertion to verify the feasibility and reliability of the system. Results: The mean operative duration was 29.1 (SD 4.3) minutes. The cadavers required no more than two attempts to achieve desired wire placement, with the mean positioning-error being 2.0 (SD 0.3) mm and the mean angle-deviation 3.6 (SD 0.7)°. Throughout the study, a mean of 2.2 full-cycle fluoroscopy attempts was required for each cadaver during surgery, and no preoperative CT scan was needed. Conclusions: The outcomes show that using the automatic surgical robot to perform the percutaneous scaphoid guide pin insertion is feasible and desired results can be achieved.

Percutaneous fixation of scaphoid fractures through the snuffbox: an anatomical study.

The aim of the present anatomical study was to assess the dorso-radial approach for percutaneous fixation of scaphoid wist fractures. Through the anatomical snuffbox, cannulated screws or 1.2 mm K-wires were inserted into the scaphoids of 20 fresh-frozen cadavers. No tendon injuries were observed. There were two lesions of the radial artery, and three lesions of the sensory branches of the radial nerve. After dissection and three-dimensional CT reconstruction, the K-wire or screw position was described in relation to the scaphoid centroid and its longitudinal axis. The mean distance between the device and the scaphoid centroid was 2.8 mm (SD 1.4, range 0.6 to 6.1). The mean angle between the device and the scaphoid's longitudinal axis was 29° (SD 11, range 6.5 to 54). Rather than percutaneous fixation, an open approach with a modest incision might be safer for identifying and protecting both the radial artery and the sensory nerves. This approach would make perpendicular fixation possible for specific patterns of scaphoid fracture orientated approximately 60° from the longitudinal axis.

A Finite Element Comparison Between Two Sizes of NiTi Commercial Staples Used in Scaphoid Fracture Fixation

A Finite Element Comparison Between Two Sizes of NiTi Commercial Staples Used in Scaphoid Fracture Fixation

Computational modeling of nickel–titanium orthopedic staples in the treatment of a fractured scaphoid: Effects of staple bridge configuration

Internal fixation devices made of nickel-titanium (NiTi) staples have the advantage of producing compressive stress at the fracture site due to their unique shape memory effect and superelasticity. In the present study, a comparison was made between two commercial NiTi staples of the same size but with different bridge configurations, used for scaphoid fracture fixation. The staple and scaphoid anatomical configurations were modeled using SolidWorks, while ABAQUS software was used to analyze the stress and displacement caused by staples and distributed in the scaphoid waist. In the staple with a straight bridge, the regions under the tips of the staple legs underwent the largest stress, whereas there was negligible stress in the regions closer to the staple bridge. In the staple with an S-shaped bridge, the stress concentration was highly localized in the region close to the staple bridge, with a maximum stress that was over eight times higher than in the staple with a straight bridge. Considering the amount and distribution of stress in both staples, neither of the staples was able to create the ideal healing condition on the fracture surface.

Functional Outcomes of Fixation of the Scaphoid Fracture with Herbert Screw: A Cross-Sectional Study

Objective: The present study aims at the assessment of the radiological union and clinical outcomes of scaphoid fracture followed by fixation by Herbert Screw. Study design: A cross-sectional study Place and Duration: This study was conducted Muhammad Medical College and Hospital Mirpurkhas from may 2021 to may 2022 Methodology: A total of 20 patients were included in the study and all of them had sustained a scaphoid fracture. All of them were treated with Herbert screw fixation. Overall 18 of them were male and 2 were female. Serial radiographs were obtained for the assessment of union and the Modified Mayo wrist scoring (MMWS) system was used for the assessment of functional outcomes. The patients were called after 6 months of surgery for a follow-up visit. A total of 9 (45%) patients were treated within the first week of the injury. Overall 5 (25%) were treated in two weeks and 6 (30%) were treated in 2 to 4 weeks Results: Out of 20 patients included in the study, 17 had fractured at the waist of the scaphoid and the remaining 3 had sustained fractures at the proximal pole of the scaphoid. The dorsal and volar approach of fixation by Herbert Screw was used for treating all the fractures. A good alignment was observed post-operatively. Out of all the 20 patients, 12 (60%) patients showed excellent outcomes with a full range motion of the wrist, 6 (30%) had shown good results, and 2 (10%) showed poor results. A final follow-up was arranged during the sixth month of treatment and 18 (90%) patients showed adequate radiological union. Conclusion: Fixation of scaphoid fracture with a Herbert Screw in a convenient and effective mode of treatment which has shown excellent functional outcomes and exceptionally reduced complications. Keywords: Herbert Screw, Fixation, Functional outcomes, Scaphoid fracture

Determining the optimal radiologic wrist and forearm position to visualize screw protrusion in scaphoid fixation.

Surgical fixation of scaphoid fractures may result in unrecognized screw protrusion and subsequent cartilage damage to the adjacent joints. The purpose of this study was to use a three-dimensional (3D) scaphoid model to determine the wrist and forearm positioning that will allow intra-operative fluoroscopic visualization of screw protrusions. Two 3D scaphoid models, with the wrist in neutral and 20° ulnar deviated, were reconstructed from a cadaveric wrist using the Mimics software. The scaphoid models were divided into three segments and further divided into four quadrants in each of the three segments along the scaphoid axes. Two virtual screws, with a 2 and 1 mm groove from the distal border, were placed so that the screws protrude from each quadrant. The wrist models were rotated along the long axis of the forearm and the angles at which the screw protrusions were visualized were recorded. One-millimetre screw protrusions were visualized at a narrower range of forearm rotation angles compared to 2 mm screw protrusions. One-millimetre screw protrusions in the middle dorsal ulnar quadrant could not be detected. Visualization of the screw protrusion in each quadrant varied with forearm and wrist positioning. In this model, all screw protrusions, except 1 mm protrusions in the middle dorsal ulnar quadrant, were visualized with the forearm in pronation, supination or in the mid-pronation position and with the wrist in neutral or 20° ulnar deviated.

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

BackgroundAllograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union.Patients and methodsWe retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union.ResultsUsing the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate.ConclusionUsing the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars.Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

Internal fixation of acute scaphoid proximal pole &amp; waist fractures using the dorsal mini open technique without bone grafting

The navicular bone of the hand is the most frequently fractured bone among the carpal bones, and if not treated well, it may result in nonunion. Dorsal, volar open, or percutaneous approaches can be used in surgical treatment. We aimed to evaluate the results of internal fixation of scaphoid fractures with the dorsal mini-open technique. Patients with acute proximal and waist fractures who have been treated with cannulated compression screws with a dorsal mini open approach without grafting between 2015 and 2020 were included. Functional outcomes were analyzed with the DASH questionnaire and MAYO wrist performance scores and compared with the contralateral wrists. The mean age of the patients was 35.6 ±10.8 years (range 20-55), seven were proximal, and 13 were waist fractures. The mean time to surgery was 16±7.3 days (range 5-30) and the mean follow-up time was 47.5±20.2 weeks (range 20-84). The mean DASH score at the last follow-up was 5.9±3.3 points (range 2.5-11.7), and the Mayo wrist performance score was 96.8±5.2 points (range 85-100). In one proximal pole fracture, cracking occurred on the cartilage surface at the screw insertion site but consolidated without any additional intervention. The mean time to union was 8.5±1.2 weeks (range 7-11). Waist region fractures consolidated faster than proximal pole fractures (p=0.002). No significant difference was found between the fracture site and mid-term functional results. Complications like proximal cartilage fractures during the embedding of the screw head or prominence of the screw head can be avoided with the dorsal mini-open technique which is a safe and effective method.

The clinical application of individualized three-dimensional printing guiding template for assisting scaphoid fracture fixation through dorsal approach

The purpose is to introduce a novel scaphoid screw placement surgery based on a novel three-dimensional (3D) printing guiding template through dorsal approach, and to evaluate the clinical feasibility and accuracy. The diagnose of scaphoid fracture was confirmed by Computed Tomography (CT) scanning, and subsequently the CT scanning data was input into a three-dimension imaging system(Hongsong software, China). An individualized 3D skin surface template with a guiding hole was printed. We put the template to the correct position on patient's wrist. Fluoroscopy was used to confirm the accurate position after drilling of Kirschner wire according to the prefabricated holes of template. Finally, the hollow screw was inserted through the wire. The operations were performed successfully without incision and complications. The operation time was below 20 minutes and the blood loss was below 1ml. The intraoperative fluoroscopy demonstrated good position of the screws. Postoperative imaging showed that the screws were considered to be placed perpendicularly to the fracture plane in the scaphoid. Three months after the operation, the patients acquired good recovery of the motor function of their hands. This present study suggested that the computer-assisted 3D printing guiding template is effective, reliable, and minimally invasive for the treatment of type B scaphoid fracture through dorsal approach.

An innovative technique - Axial Loading and Compression Fixation (ALCF Technique) of scaphoid fracture by percutaneous K-wire

Backgrounds Surgical fixation techniques used for the treatment of scaphoid fracture is still a topic of discussion among hand surgeons especially in terms of approach, implants and surgical techniques. We present an innovative technique of scaphoid fracture fixation by K-wire, which we accidentally encountered when the guide wire broke while doing a cannulated screw for the scaphoid. This technique of axial aligning, compression loading over a bent tip of K-wire across the fracture fragments of scaphoid is innovative. Materials The study included 16 patients operated for Scaphoid fracture between January-2017 to January-2020 by ALCF Technique. the patient age ranged from 18 to 69 years,M:F12:4, 13 fractures on dominant hand,10 fracture presented within 2 weeks, 7 were trans-scaphoid displaced fractures sustained in RTA, 3 proximal pole fractures sustained after a fall, 6 were delayed presentation more than 3 months. Method The technique used to pass a K wire from dorsally in ante grade fashion to align the fracture fragments along the anatomical axis of the scaphoid then bend the K wire at the proximal end so as to hook the proximal fragment. The distal end of the K wire is then applied manual traction load with gentle rotation to achieve compression at the fracture ends with rotational alignment on the distal fragment. The distal fragment is anvil on the proximal fragment by a K-wire binder before distally binding to achieve compression &amp; relative stable fixation. Conclusion It is a simple, easy to reproduce, economic method to achieve reduction, compression using axial traction and union in all types of scaphoid fractures.

Surgical management of slightly or non-displaced corporal scaphoid fractures by retrograde percutaneous screw fixation through the anterior trapezium horn: A single-center retrospective French study of 33 patients between January 2015 and January 2019

Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches. We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw. We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients. Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery. The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium.

Does the Use of Gelled Platelet-Rich Plasma during Fixation of Subacute Proximal Pole Scaphoid Fractures Help? – A Single Centre Experience

Background: Subacute proximal pole scaphoid fractures (1 month to 6 months) have a higher risk of non-union. The aim of the present retrospective analysis is to evaluate the efficacy of gelled platelet-rich plasma (GPRP) as additional treatment to antegrade headless screw fixation of proximal pole scaphoid fractures. Methods: Forty-one patients were divided into two groups based on surgical treatment received: screw fixation alone (group A) and screw fixation and GPRP application at the fracture site (group B). A short cast was maintained for 4 weeks after surgery. Outcome measures included time to union, need for additional procedures, time to return to work, disabilities of the arm, shoulder, and hand (DASH) questionnaire, Michigan Hand Questionnaire (MHQ) and Mayo wrist score (MWS).Time to union was determined by monthly radiographs and confirmed by a computerized tomographic (CT) scan done at 4 months. Results: Union was achieved in 85.7% of patients in group A and in 100% of patients in group B. Patients in group B showed a faster time to healing (2.3 ± 0.4 months vs 3.1 ± 0.7 months, p = 0.0001) and earlier return to work (10.4 ± 2.2 vs 15.1 ± 2.9, p = 0.0001). There were no significant differences in patient-rated outcomes scores between the two groups at final follow-up. Conclusions: Internal fixation alone is effective in treating subacute proximal pole scaphoid fractures. GPRP application improves bone healing and functional recovery. Level of Evidence: Level III (Therapeutic).

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture : a meta-analysis of randomized controlled trials.

There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures. A systematic review of seven databases was performed from the dates of their inception until the end of March 2021 to identify eligible RCTs. Reference lists of the included studies were screened. No language restrictions were applied. The primary outcome was the patient-reported outcome measure of wrist function at 12 months after injury. A meta-analysis was performed for function, pain, range of motion, grip strength, and union. Complications were reported narratively. Seven RCTs were included. There was no significant difference in function between the groups at 12 months (Hedges' g 0.15 (95% confidence interval -0.02 to 0.32); p = 0.082). The complication rate was higher in the operative group and involved more serious complications. We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. The complication rate was higher with operative treatment. Cite this article: Bone Joint J2022;104-B(8):953-962.

Bone Morphogenic Protein-2 Use for the Surgical Treatment of Acute Scaphoid Fractures and Scaphoid Nonunions.

Bone morphogenic protein-2 has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive bone morphogenic protein-2 to further characterize bone morphogenic protein-2 use in the hand and wrist. Retrospective review of scaphoid fractures treated surgically in one region of the Military Health System from 2009 to 2019 was conducted to identify cases using bone morphogenic protein-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior nonunions, union rates at 4 and 6 weeks, and functional outcomes. Fourteen patients met inclusion criteria. Nonunions accounted for 50 percent of included fractures. The total union rate was 93 percent. Mean time to union was 6.2 weeks. All acute fractures healed with a mean time to union of 4.8 weeks. Nonunions had a union rate of 86 percent, with a mean time to union of 7.7 weeks. Four patients (29 percent) developed radiographic heterotopic ossification; however, no significant decrease in motion was appreciated. Thirteen patients (93 percent) resumed the push-ups portion of the military fitness test. No major complications were identified during follow-up. Adjunctive use of bone morphogenic protein-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess whether adjunctive bone morphogenic protein-2 use in scaphoid fractures provides significant benefit compared with other treatments. Therapeutic, IV.

Comparison of conventional and transtrapezial palmar approaches for screw fixation of scaphoid waist fractures: a clinical study.

We investigated two palmar approaches for screw fixation of acute scaphoid waist fractures: the conventional percutaneous or transtrapezial approach. Thirty cases who underwent operation from 2013 to 2021 were reviewed (conventional group, 15; transtrapezial approach group, 15). Cross-sections were constructed along the long axis of the scaphoid on postoperative computed tomography to evaluate the screw position, relative to the centre point in the distal-third, midwaist and proximal-third of the bone. The screw could be inserted centrally in the proximal and distal regions using the transtrapezial approach. In the conventional approach, the screw was inserted radially in the distal region, but tended to be positioned centrally in the midwaist and proximal regions. As central placement of the screw in the proximal fragment offers a biomechanical advantage, both approaches can be options for some fracture patterns, while for others, the fracture pattern could influence which approach is better.Level of evidence: IV.