Surgical Visualization of Scaphoid Fractures: A Three-Dimensional Study Comparing Dorsal and Volar Approaches

The optimal surgical approach for visualizing fractures of the scaphoid in different locations is often unclear. In this study, we aimed to define and quantify the observable surface areas of different surgical approaches for scaphoid fractures. In addition, we looked to demonstrate the utility of handheld 3D surface scanning for the in situ measurement of visible bone using different approaches.

Six cadaveric specimens each underwent 3 surgical approaches to the scaphoid: dorsal, before and after the removal of the dorsal ridge soft tissues (DRST), and volar. Three-dimensional (3D) surface scans were taken of both the in situ surgical field and, after the approaches were completed and visible regions marked, the excised bone. The overall area and locations of the exposed bone were determined, and the area of bone measured within the surgical field scan and excised bone compared.

In terms of the overall visible surface area, the dorsal approach with DRST removed provided the most exposure, followed by the volar approach, and the dorsal approach with intact DRST. For visualization of the scaphoid waist, the volar approach was found to provide the surgeon with the greatest visible surface area. The 3D surface scanning technique was found to accurately capture in situ morphology of the exposed bone.

The findings from this study help inform the best surgical approach to use for fractures of the scaphoid. Three-dimensional surface scanning may be used to quantify exposed regions of bone and may be a useful tool for teaching and as part of a surgical guidance system.