3-dimensional analysis of scaphoid fracture angle morphology

Area of Science:

• Orthopedic surgery
• Radiology
• Biomechanics

Background:

• Scaphoid fractures are commonly classified by their 2D radiographic appearance.
• Transverse waist fractures are traditionally considered the most frequent type.
• This classification may not accurately reflect the true fracture orientation.

Purpose of the Study:

• To challenge the traditional classification of scaphoid fractures.
• To determine the actual orientation of scaphoid fractures relative to the scaphoid's longitudinal axis.
• To investigate if most scaphoid fractures are indeed transverse.

Main Methods:

• Utilized 3D analysis of 124 CT scans of acute scaphoid fractures.
• Analyzed the angle between the scaphoid's longitudinal axis and the fracture plane.
• Assessed fracture location and displacement, including virtual reduction for displaced fractures.

Main Results:

• Identified 86 waist, 13 distal, and 25 proximal scaphoid fractures.
• The average fracture angle was 53° overall and 56° for waist fractures, significantly deviating from 90° (transverse).
• Most fractures exhibited a horizontal oblique inclination.

Conclusions:

• The majority of scaphoid waist fractures are horizontal oblique, not transverse.
• Current fixation techniques targeting the longitudinal axis may not be optimal for all scaphoid fractures.
• A revised approach considering the actual fracture plane is recommended for improved fixation.