Validity of computed tomography in predicting scaphoid screw prominence: a cadaveric study

Area of Science:

• Orthopedic surgery
• Radiology
• Biomedical engineering

Background:

• Hardware protrusion after fracture fixation can cause discrepancies between actual and radiographic appearance.
• Assessing screw prominence in scaphoid fractures is crucial for optimal outcomes.

Purpose of the Study:

• To determine if computed tomography (CT) accurately visualizes scaphoid screw head prominence.
• To confirm if CT-detected prominence is a true finding or a result of metal artifact.

Main Methods:

• Forty-two cadaveric wrists underwent open dorsal placement of Acutrak® headless compression screws.
• Screw head prominence (0, 1, 2, 3 mm) was surgically created and measured.
• CT scans with metal suppression were performed, and radiologists assessed prominence.

Main Results:

• Only 1 of 21 control specimens (no intentional prominence) showed apparent prominence.
• 90% of specimens with 1, 2, or 3 mm of screw head prominence were accurately identified on CT.

Conclusions:

• CT scanning accurately assesses scaphoid screw head prominence.
• Apparent prominence on CT indicates true hardware protrusion, minimizing concerns about metallic artifact.