Percutaneous Fixation Of Scaphoid Fractures Research Articles

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.

Segmentation of the Scaphoid Bone in Ultrasound Images

Abstract For the percutaneous fixation of scaphoid fractures, navigated approaches have been proposed to facilitate screw placement. Based on ultrasound imaging, navigation can be carried out in a cost-effective and fast manner, furthermore avoiding harmful radiation. For this purpose, a fast and efficient architecture for the automated segmentation of scaphoid bone in ultrasound volume images is needed. Methods: For 2D segmentation of the scaphoid, two architectures are taken into account: 2D nnUNet and Deeplabv3+. These architectures are trained and evaluated on a newly created dataset consisting of 67 annotated in-vivo ultrasound volume images (4576 slice images). Results: In terms of Dice coefficient, the 2D nnUNet achieves 0.67 compared to 0.57 for the Deeplabv3+. In terms of distance metrics, the 2D nnUNet shows an average symmetric surface distance error of 0.66mm, while the Deeplabv3+ achieves 0.55mm. Conclusion: Fast and accurate segmentation of the scaphoid in ultrasound volumes is feasible. Both architectures show competitive results.

A study of functional and radiological outcome of undisplaced scaphoid fracture treated with percutaneous Herbert screw fixation

Introduction: The management of undisplaced fractures of the scaphoid is controversial. Conventional management of these fractures has been with significant risk of scaphoid nonunion. Objectives: Our objective was to study if early per-cutaneous fixation of scaphoid fractures results in early return to work and sports activities, better union rates, better pain relief and better range of motion of wrist. Methodology: This study examined the results from 30 patients who underwent per-cutaneous screw fixation using a Herbert screw in an un-displaced scaphoid fracture. All patients in the study group were followed up for average 2 years evaluating them according to the Green & O’Brien score. Results: All had healed successfully after the index procedure. There were three complications consisting of wrist pain and decreased range of motion of wrist. These also went on to heal, resulting in better union rates. Conclusion: Thus per-cutaneous fixation of acute, un-displaced scaphoid fractures with percutaneous Herbert screws is an effective treatment which reduces the need of prolonged immobilization and helps in an early return to the routine activity.

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients.

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8weeks. At a mean follow-up of 6.5months (range 6-8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV.

Scaphoid fractures with scapholunate ligament involvement: Instability or ligamentous laxity? Role of arthroscopy and pinning.

Percutaneous fixation of scaphoid fractures often does not allow the evaluation of potential ligamentous lesions. Arthroscopy is an useful tool in the management of scaphoid fractures to visualize potentially associated lesions. With arthroscopic assistance, we often found scapholunate ligament lesions. Our study's aim was to evaluate the role of arthroscopy in the treatment of scaphoid fracture and in particular if the alteration found was a real lesion causing instability or just a paraphysiologic laxity. Furthermore, we evaluated whether the scapholunate joint pinning alters the outcome. We performed a retrospective study on 39 patients (33 males and 6 females), with an average age at trauma of 31.2years (range 15-67), who underwent surgery for scaphoid fractures between 2010 and 2016 in our Center of Hand Surgery. Patients were divided into four groups based on surgical technique and finding of scapholunate lesions. Differences between the four groups analyzed, both in terms of clinical scores and ROM, were not statistically significant. This corroborates the hypothesis that all four treatments are equivalent. Based on our experience and the literature available, we believe the systematic use of arthroscopy to be useful in patients needing surgical treatment for scaphoid fractures. This is because arthroscopy allows the control of the fracture reduction, screw protrusion evaluation and ligamentous lesions assessment. In cases of partial scapholunate ligament alteration in which no sign of acute lesion is present (hemorrhage and clear rupture), pinning is not necessary since it might just be a paraphysiologic laxity. IV.

Volume rendering of three-dimensional fluoroscopic images for percutaneous scaphoid fixation: An in vitro study

Percutaneous fixation of scaphoid fractures offers potential advantages to cast treatment but can be difficult to perform with conventional two-dimensional imaging. This study aimed to evaluate the use of a novel navigation technique using volume-rendered images derived from intraoperative cone-beam computed tomography imaging, without the need for typical patient-based registration. Randomized in vitro trials in which a guidewire was inserted into a scaphoid model were conducted to compare volumetric navigation to conventional fluoroscopic C-arm (n = 24). Central wire placement, surface breach, procedure time, drilling attempts, and radiation exposure were compared between groups. Compared to conventional percutaneous insertion, navigation achieved equal or significantly better placement of the guidewire with fewer drilling attempts and less radiation exposure. On average, navigation took 74 s longer to perform than the conventional method, which was statistically significant but clinically irrelevant. This evaluation suggests that the technology is promising and may have many clinical benefits including improved fixation placement, fewer complications, and less radiation exposure. The intraoperative workflow is more efficient and eliminates the need for preoperative computed tomography, image segmentation, and patient-based registration typical of traditional navigated procedures.

A Comparison of 2 Methods for Scaphoid Central Screw Placement From a Volar Approach

We studied 2 methods used for screw placement through a volar approach for fixation of scaphoid fractures. We performed measurements on 20 computed tomography scans of unfractured scaphoids. A central virtual guidewire was computed in 10 scaphoids with the wrist in neutral or in extension and ulnar deviation. Second, we compared the central guidewire and a guidewire representing a volar approach to the scaphoid avoiding the trapezium. The central guidewire passed through the trapezium in all cases with the wrist either in neutral or in extension and ulnar deviation. There was a statistically significant difference only in the sagittal plane. When the central guidewire was compared with a guidewire placed through a standard volar approach, the latter was more eccentric in the distal and waist portions. We showed that central placement throughout the scaphoid with a standard volar approach is not feasible without partially resecting, manipulating, or drilling through the trapezium. Our data suggest that a volar transtrapezial approach can be an alternative for optimum central placement in volar percutaneous fixation of scaphoid fractures.

Percutaneous fixation of selected scaphoid fractures by dorsal approach

The aim of our study was to evaluate clinical, radiological and functional outcomes of selected cases of percutaneous fixation of scaphoid fractures via a dorsal approach. Percutaneous fixation by dorsal approach was done in 32 patients (mean age 32.2 years) involving both fresh and late scaphoid fracture presentations (mean 17 days). Fourteen cases of B1 type, ten cases of B2 and eight cases of C type (Herbert's classification) were treated. The patients were prospectively followed up clinically and radiologically for a minimum follow-up of 14 months (mean 16 months), and functional outcome and complications were assessed. All fractures united over an average of nine weeks. There was no avascular necrosis or screw cutout with preservation of wrist movement and grip strength. There were no injuries to any at risk anatomical structures. Percutaneous fixation of scaphoid fractures through dorsal approach gives good clinical and functional outcome in acute and chronic scaphoid fractures of B1, B2 and C types (Herbert's classification).

Percutaneous Fixation of Scaphoid Fractures

Recent advances in techniques and implants have led to renewed interest in percutaneous screw fixation of acute scaphoid fractures. The closed (cast) treatment of acute scaphoid fractures generally has good outcome, with bony union resulting; however, closed treatment can result in delayed union, nonunion, malunion, cast- induced joint stiffness, and lost time from employment and avocations. Acute percutaneous fixation of scaphoid fracture has been proposed as a means to minimize some of the complications of closed (cast) treatment. Percutaneous treatment of both nondisplaced and displaced scaphoid fractures reportedly can achieve a nearly 100% union rate with minimal complications. Fixation of scaphoid fractures with headless compression screws can be done using both volar and dorsal approaches. The fracture reduction and alignment are assessed by fluoroscopy and arthroscopy. Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture.

7.5 Percutaneous fixation of scaphoid fractures with the twin-fix screw

7.5 Percutaneous fixation of scaphoid fractures with the twin-fix screw

Arthroscopic Reduction and Percutaneous Fixation of Scaphoid Fractures With a Novel Dorsal Technique

This article presents a technical description of a novel dorsal technique of arthroscopic reduction and percutaneous fixation of scaphoid fractures. Background highlighting the evolution of this technique is described. A series of patients treated in this manner, all of whom have healed without complications, is presented.

Percutaneous fixation of scaphoid fractures An anatomical study

Percutaneous scaphoid fracture fixation has many advantages over the open method of fixation. We describe the anatomical basis for a safe percutaneous approach. Cannulated screws were inserted into 32 cadaveric scaphoids through 1 cm palmar incisions under fluoroscopic control. We then measured the distance between the entry point in the scaphoid and important local neurovascular structures. We also measured the angle of entry of the guide wire in two planes. The mean distance of the entry point from the main radial artery was 14 mm (range, 7–24 mm); from the radial nerve 19 mm (range, 7–35 mm); from the recurrent branch of the median nerve 29 mm (range, 14–45 mm); and from the superficial branch of the radial artery 5 mm (range, 0–8 mm) The mean radial angle of insertion was 34° and the mean palmar angle of insertion was 58°. Percutaneous fixation of scaphoid fractures puts the superficial palmar branch of the radial artery at risk. We recommend a 1 cm incision centred over the scaphotrapezial joint and dissection under direct vision to the entry point in the scaphoid rather than a completely percutaneous approach.