J Wrist Surg 2018; 07(01): 066-070
DOI: 10.1055/s-0037-1605381
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variable Bone Density of Scaphoid: Importance of Subchondral Screw Placement

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

Publication History

14 November 2016

10 July 2017

Publication Date:
08 August 2017 (online)

Abstract

Background Ideal internal fixation of the scaphoid relies on adequate bone stock for screw purchase; so, knowledge of regional bone density of the scaphoid is crucial.

Questions/Purpose The purpose of this study was to evaluate regional variations in scaphoid bone density.

Materials and Methods Three-dimensional CT models of fractured scaphoids were created and sectioned into proximal/distal segments and then into quadrants (volar/dorsal/radial/ulnar). Concentric shells in the proximal and distal pole were constructed in 2-mm increments moving from exterior to interior. Bone density was measured in Hounsfield units (HU).

Results Bone density of the distal scaphoid (453.2 ± 70.8 HU) was less than the proximal scaphoid (619.8 ± 124.2 HU). There was no difference in bone density between the four quadrants in either pole. In both the poles, the first subchondral shell was the densest. In both the proximal and distal poles, bone density decreased significantly in all three deeper shells.

Conclusion The proximal scaphoid had a greater density than the distal scaphoid. Within the poles, there was no difference in bone density between the quadrants. The subchondral 2-mm shell had the greatest density. Bone density dropped off significantly between the first and second shell in both the proximal and distal scaphoids.

Clinical Relevance In scaphoid fracture ORIF, optimal screw placement engages the subchondral 2-mm shell, especially in the distal pole, which has an overall lower bone density, and the second shell has only two-third the density of the first shell.

Note

This work was performed at the Hospital for Special Surgery, New York.


 
  • References

  • 1 Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am 2012; 37 (05) 1095-1100
  • 2 Symes TH, Stothard J. A systematic review of the treatment of acute fractures of the scaphoid. J Hand Surg Eur Vol 2011; 36 (09) 802-810
  • 3 Buijze GA, Doornberg JN, Ham JS, Ring D, Bhandari M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2010; 92 (06) 1534-1544
  • 4 Hoogbergen MM, Niessen WJ, Schuurman AH, Spauwen PH, Kauer JM. Subchondral bone mineral density patterns representing the loading history of the wrist joint. J Hand Surg Br 2002; 27 (02) 150-154
  • 5 Lee SB, Kim HJ, Chun JM. , et al. Osseous microarchitecture of the scaphoid: Cadaveric study of regional variations and clinical implications. Clin Anat 2012; 25 (02) 203-211
  • 6 Cheung YY, Naspinsky SR, Goodwin DW, Murphy JM, Nutting JT. Increased radiodensity of the proximal pole of the scaphoid: a common finding in computed tomography imaging of the wrist. J Comput Assist Tomogr 2006; 30 (05) 850-857
  • 7 Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 2011; 93 (11) 1057-1063
  • 8 Schreiber JJ, Gausden EB, Anderson PA, Carlson MG, Weiland AJ. Opportunistic osteoporosis screening - gleaning additional information from diagnostic wrist CT scans. J Bone Joint Surg Am 2015; 97 (13) 1095-1100
  • 9 Faran KJ, Ichioka N, Trzeciak MA, Han S, Medige J, Moy OJ. Effect of bone quality on the forces generated by compression screws. J Biomech 1999; 32 (08) 861-864
  • 10 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
  • 11 Ab-Lazid R, Perilli E, Ryan MK, Costi JJ, Reynolds KJ. Pullout strength of cancellous screws in human femoral heads depends on applied insertion torque, trabecular bone microarchitecture and areal bone mineral density. J Mech Behav Biomed Mater 2014; 40: 354-361
  • 12 Reynolds KJ, Cleek TM, Mohtar AA, Hearn TC. Predicting cancellous bone failure during screw insertion. J Biomech 2013; 46 (06) 1207-1210
  • 13 Lehman Jr RA, Kang DG, Wagner SC. Management of osteoporosis in spine surgery. J Am Acad Orthop Surg 2015; 23 (04) 253-263
  • 14 Schuind F, Cooney WP, Linscheid RL, An KN, Chao EY. Force and pressure transmission through the normal wrist. A theoretical two-dimensional study in the posteroanterior plane. J Biomech 1995; 28 (05) 587-601
  • 15 Iwasaki N, Minami A, Miyazawa T, Kaneda K. Force distribution through the wrist joint in patients with different stages of Kienböck's disease: using computed tomography osteoabsorptiometry. J Hand Surg Am 2000; 25 (05) 870-876
  • 16 Madeley NJ, Stephen AB, Downing ND, Davis TR. Changes in scaphoid bone density after acute fracture. J Hand Surg Br 2006; 31 (04) 368-370
  • 17 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
  • 18 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
  • 19 Todisco M, Trisi P. Bone mineral density and bone histomorphometry are statistically related. Int J Oral Maxillofac Implants 2005; 20 (06) 898-904
  • 20 Norton MR, Gamble C. Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 2001; 12 (01) 79-84
  • 21 Alho A, Husby T, Høiseth A. Bone mineral content and mechanical strength. An ex vivo study on human femora at autopsy. Clin Orthop Relat Res 1988; 227 (227) 292-297