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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
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Publikationsverlauf

08. August 2016

25. Oktober 2016

Publikationsdatum:
01. Dezember 2016 (online)

    Lizenzen und Reprints

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.


 

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