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J Wrist Surg 2017; 06(03): 178-182
DOI: 10.1055/s-0036-1596059
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Screw Perpendicularity on Compression in Scaphoid Waist Fractures

Morgan M. Swanstrom
1   Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Kyle W. Morse
1   Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Joseph D. Lipman
2   Department of Biomechanics, Hospital for Special Surgery, New York, New York
,
Krystle A. Hearns
1   Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Michelle G. Carlson
1   Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

08 August 2016

25 October 2016

Publication Date:
01 December 2016 (online)

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Abstract

Background Central and perpendicular (PERP) screw orientations have each been described for scaphoid fracture fixation. It is unclear, however, which orientation produces greater compression.

Questions/Purposes This study compares compression in scaphoid waist fractures with screw fixation in both PERP and pole-to-pole (PTP) configurations. PERP orientation was hypothesized to produce greater compression than PTP orientation.

Methods Ten preoperative computed tomography scans of scaphoid waist fractures were classified by fracture type and orientation in the coronal and sagittal planes. Three-dimensional models of each scaphoid and fracture plane were created. Simulated Acutrak 2 (Acumed, Hillsboro, OR) screws were placed into the models in both PERP and PTP orientations. Engagement length and screw angle relative to the fracture were measured. Compression strength was calculated from the shear area, average density, and angle acuity.

Results The PTP angle between screw and fracture ranged from 36 to 84 degrees. By definition, the PERP screw-to-fracture angle was 90 degrees. Perpendicularity of the PTP screw to the fracture was positively correlated to compression strength. PERP screws had greater compression than PTP screws when the PTP screw-to-fracture angle was < 80 degrees (106 vs. 80 N), but there was no difference in compression when the PTP screw-to-fracture angle was > 80 degrees, approximating the PERP screw.

Conclusion Increasing screw perpendicularity resulted in higher compression when the screw-to-fracture angle of the PTP screw was < 80 degrees. Maximum compression was obtained with a screw PERP to the fracture. The increased compression gained from PERP screw placement offsets the decreased engagement length.

Clinical Relevance These results provide guidelines for optimal screw placement in scaphoid waist fractures.

Keywords

scaphoid - fracture - compression - screw fixation

Note

Institutional Ethical Board Review approval was obtained from Hospital for Special Surgery's IRB. Work was performed at the Hospital for Special Surgery, New York.


 

  • References

  • 1 McCallister WV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am 2003; 85 -A (01) 72-77
    CrossrefPubMedGoogle Scholar
  • 2 Dodds SD, Panjabi MM, Slade III JF. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 2006; 31 (03) 405-413
    CrossrefPubMedGoogle Scholar
  • 3 Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996; 78 (12) 1829-1837
    CrossrefPubMedGoogle Scholar
  • 4 Luria S, Hoch S, Liebergall M, Mosheiff R, Peleg E. Optimal fixation of acute scaphoid fractures: finite element analysis. J Hand Surg Am 2010; 35 (08) 1246-1250
    CrossrefPubMedGoogle Scholar
  • 5 Luria S, Lenart L, Lenart B, Peleg E, Kastelec M. Optimal fixation of oblique scaphoid fractures: a cadaver model. J Hand Surg Am 2012; 37 (07) 1400-1404
    CrossrefPubMedGoogle Scholar
  • 6 Faucher GK, Golden III ML, Sweeney KR, Hutton WC, Jarrett CD. Comparison of screw trajectory on stability of oblique scaphoid fractures: a mechanical study. J Hand Surg Am 2014; 39 (03) 430-435
    CrossrefPubMedGoogle Scholar
  • 7 Hart A, Harvey EJ, Lefebvre LP, Barthelat F, Rabiei R, Martineau PA. Insertion profiles of 4 headless compression screws. J Hand Surg Am 2013; 38 (09) 1728-1734
    CrossrefPubMedGoogle Scholar
  • 8 Fowler JR, Ilyas AM. Headless compression screw fixation of scaphoid fractures. Hand Clin 2010; 26 (03) 351-361 , vi
    CrossrefPubMedGoogle Scholar
  • 9 Gruszka DS, Burkhart KJ, Nowak TE, Achenbach T, Rommens PM, Müller LP. The durability of the intrascaphoid compression of headless compression screws: in vitro study. J Hand Surg Am 2012; 37 (06) 1142-1150
    CrossrefPubMedGoogle Scholar
  • 10 Assari S, Darvish K, Ilyas AM. Biomechanical analysis of second-generation headless compression screws. Injury 2012; 43 (07) 1159-1165
    CrossrefPubMedGoogle Scholar
  • 11 Crawford LA, Powell ES, Trail IA. The fixation strength of scaphoid bone screws: an in vitro investigation using polyurethane foam. J Hand Surg Am 2012; 37 (02) 255-260
    CrossrefPubMedGoogle Scholar
  • 12 Sugathan HK, Kilpatrick M, Joyce TJ, Harrison JW. A biomechanical study on variation of compressive force along the Acutrak 2 screw. Injury 2012; 43 (02) 205-208
    CrossrefPubMedGoogle Scholar
  • 13 Grewal R, Assini J, Sauder D, Ferreira L, Johnson J, Faber K. A comparison of two headless compression screws for operative treatment of scaphoid fractures. J Orthop Surg 2011; 6: 27
    CrossrefPubMedGoogle Scholar
  • 14 Pensy RA, Richards AM, Belkoff SM, Mentzer K, Andrew Eglseder W. Biomechanical comparison of two headless compression screws for scaphoid fixation. J Surg Orthop Adv 2009; 18 (04) 182-188
    PubMedGoogle Scholar
  • 15 Hausmann JT, Mayr W, Unger E, Benesch T, Vécsei V, Gäbler C. Interfragmentary compression forces of scaphoid screws in a sawbone cylinder model. Injury 2007; 38 (07) 763-768
    CrossrefPubMedGoogle Scholar
  • 16 Beadel GP, Ferreira L, Johnson JA, King GJW. Interfragmentary compression across a simulated scaphoid fracture--analysis of 3 screws. J Hand Surg Am 2004; 29 (02) 273-278
    CrossrefPubMedGoogle Scholar
  • 17 Newport ML, Williams CD, Bradley WD. Mechanical strength of scaphoid fixation. J Hand Surg [Br] 1996; 21 (01) 99-102
    CrossrefPubMedGoogle Scholar
  • 18 Shaw JA. Biomechanical comparison of cannulated small bone screws: a brief follow-up study. J Hand Surg Am 1991; 16 (06) 998-1001
    CrossrefPubMedGoogle Scholar
  • 19 Tencer AF, Asnis SE, Harrington RM, Chapman JR. Biomechanics of cannulated and noncannulated screws. In: Asnis SE, Kyle RF. , eds. Cannulated Screw Fixation: Principals and Operative Techniques. New York: Springer; 1996: 15-40
    Google Scholar
  • 20 Crookshank M, Ploeg HL, Ellis R, MacIntyre NJ. Repeatable calibration of hounsfield units to mineral density and effect of scanning medium. Advances in Biomechanics and Applications 2014; 1 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 21 Carter DR, Hayes WC. Bone compressive strength: the influence of density and strain rate. Science 1976; 194 (4270): 1174-1176
    CrossrefPubMedGoogle Scholar
  • 22 Haisman JM, Rohde RS, Weiland AJ. ; American Academy of Orthopaedic Surgeons. Acute fractures of the scaphoid. J Bone Joint Surg Am 2006; 88 (12) 2750-2758
    CrossrefPubMedGoogle Scholar
  • 23 Shin AY, Horton T, Bishop AT. Acute coronal plane scaphoid fracture and scapholunate dissociation from an axial load: a case report. J Hand Surg Am 2005; 30 (02) 366-372
    CrossrefPubMedGoogle Scholar
  • 24 Ng KCK, Leung YF, Lee YL. Coronal fracture of the scaphoid--a case report and literature review. Hand Surg 2014; 19 (03) 423-425
    CrossrefPubMedGoogle Scholar
  • 25 Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am 1960; 42-A: 759-768
    Google Scholar
  • 26 Kozin SH. Incidence, mechanism, and natural history of scaphoid fractures. Hand Clin 2001; 17 (04) 515-524
    PubMedGoogle Scholar
  • 27 Kobayashi M, Garcia-Elias M, Nagy L. , et al. Axial loading induces rotation of the proximal carpal row bones around unique screw-displacement axes. J Biomech 1997; 30 (11/12) 1165-1167
    CrossrefPubMedGoogle Scholar
  • 28 Garcia-Elias M. Kinetic analysis of carpal stability during grip. Hand Clin 1997; 13 (01) 151-158
    CrossrefPubMedGoogle Scholar
  • 29 Smith DK, Cooney III WP, An KN, Linscheid RL, Chao EY. The effects of simulated unstable scaphoid fractures on carpal motion. J Hand Surg Am 1989; 14 (2 Pt 1): 283-291
    PubMedGoogle Scholar
  • 30 Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV. Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am 2000; 82 (05) 633-641
    CrossrefPubMedGoogle Scholar