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Related Experiment Videos

Retrograde (volar) scaphoid screw insertion-a quantitative computed tomographic analysis.

Seth Levitz1, David Ring

  • 1Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Boston, MA, USA.

The Journal of Hand Surgery
|June 1, 2005
PubMed
Summary
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Optimal volar screw placement in the scaphoid requires a radial starting point to avoid the trapezium and ensure central positioning. This technique minimizes risks associated with screw fixation, improving outcomes for scaphoid fractures.

Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Radiology

Background:

  • Scaphoid fracture fixation aims for central screw placement in the proximal pole.
  • A volar percutaneous approach is commonly used for scaphoid screw fixation.
  • Understanding anatomical constraints is crucial for safe screw insertion.

Purpose of the Study:

  • To quantify guidelines for optimal scaphoid screw insertion via a volar approach.
  • To determine safe screw insertion parameters using computed tomography (CT) measurements.
  • To evaluate the impact of screw trajectory on anatomical structures.

Main Methods:

  • Quantitative CT analysis of 15 unfractured scaphoids.
  • Measurement of screw path parameters in coronal and sagittal planes.

Related Experiment Videos

  • Assessment of radial clearance of the trapezium and volar concavity depth.

    • Main Results:

    • Screw length varied significantly with insertion path (ulnar paths required shorter screws).
    • A radial screw path offered greater clearance from the trapezium (average 3.9 mm).
    • The intermediate screw path, considered optimal, cleared the trapezium in 67% of cases.

    Conclusions:

    • The trapezium and scaphoid volar concavity pose challenges for volar screw fixation.
    • A radial starting point facilitates central screw placement and avoids the trapezium.
    • Drilling or partial excision of the trapezium may be needed for optimal screw placement.