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Scaphoid Fracture Fixation in a Nonunion Model: A Biomechanical Study Comparing 3 Types of Fixation.

Avanthi Mandaleson1, Stephen K Tham2, Craig Lewis3

  • 1Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Department of Mechanical Engineering, University of Melbourne, Parkville, Australia.

The Journal of Hand Surgery
|November 15, 2017
PubMed
Summary

For scaphoid nonunion, double screws or plate fixation offer superior stability and energy absorption compared to a single screw. This enhanced stability may enable faster patient recovery without compromising fracture healing.

Keywords:
Biomechanicsfixationfracturenonunionscaphoid

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Trauma Surgery

Background:

  • Scaphoid fracture union is multifactorial, with stability being a key determinant.
  • Scaphoid nonunion presents a challenge in orthopedic treatment, often requiring robust fixation methods.

Purpose of the Study:

  • To biomechanically compare the stability of three scaphoid fracture fixation techniques.
  • To evaluate fixation methods in a simulated scaphoid nonunion model with bone loss.

Main Methods:

  • Thirty cadaveric scaphoid specimens were used.
  • Fixation groups included: single screw, double screws, and plate fixation.
  • Biomechanical testing measured load to failure, displacement, stiffness, and energy absorbed.

Main Results:

  • Single screw fixation exhibited significantly lower load to failure and stiffness.
  • Double screw and plate fixation demonstrated superior stability and energy absorption.
  • No significant biomechanical differences were observed between double screw and plate fixation.

Conclusions:

  • Double screw or plate fixation provides greater biomechanical stability in scaphoid nonunion models.
  • These fixation methods may facilitate accelerated rehabilitation protocols.
  • Plate or double screw fixation is recommended over single screw fixation for scaphoid nonunion.