Hamate to Scaphoid Transfer for Nonreconstructable Proximal Pole Scaphoid Fractures

Abstract Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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The morphology of proximal pole scaphoid fractures: implications for optimal screw placement

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417739546 ◽

2017 ◽

Vol 43 (1) ◽

pp. 73-79 ◽

Cited By ~ 4

Author(s):

Timothy J. Luchetti ◽

Youssef Hedroug ◽

John J. Fernandez ◽

Mark S. Cohen ◽

Robert W. Wysocki

Keyword(s):

Sagittal Plane ◽

Fracture Line ◽

Screw Thread ◽

Proximal Pole ◽

Screw Insertion ◽

Scaphoid Fractures ◽

Starting Point ◽

Screw Length ◽

Sagittal Image ◽

The Ideal

The purpose of this study was to measure the radiographic parameters of proximal pole scaphoid fractures, and calculate the ideal starting points and trajectories for antegrade screw insertion. Computed tomography scans of 19 consecutive patients with proximal pole fractures were studied using open source digital imaging and communications in medicine (DICOM) imaging measurement software. For scaphoid sagittal measurements, fracture inclination was measured with respect to the scaphoid axis. The ideal starting point for a screw in the proximal pole fragment was then identified on the scaphoid sagittal image that demonstrated the largest dimensions of the proximal pole, and hence the greatest screw thread purchase. Measurements were then taken for a standard screw trajectory in the axis of the scaphoid, and a trajectory that was perpendicular to the fracture line. The fracture inclination in the scaphoid sagittal plane was 25 (SD10) °, lying from proximal palmar to dorsal distal. The fracture inclination in the coronal plane was 9 (SD16) °, angling distal radial to proximal ulnar with reference to the coronal axis of the scaphoid. Using an ideal starting point that maximized the thread purchase in the proximal pole, we measured a maximum screw length of 20 (SD 2) mm when using a screw trajectory that was perpendicular to the fracture line. This was quite different from the same measurements taken in a trajectory in the axis of the scaphoid. We also identified a mean distance of approximately 10 mm from the dorsal fracture line to the ideal starting point. A precise understanding of this anatomy is critical when treating proximal pole scaphoid fractures surgically.

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Minimally Invasive Fixation of Ultra-Small Proximal Pole Scaphoid Fractures

10.1007/978-3-030-79423-1_97 ◽

2021 ◽

pp. 891-897

Author(s):

Eugene T. Ek ◽

Kemble K. Wang

Keyword(s):

Minimally Invasive ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Minimally Invasive Fixation

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Percutaneous treatment for waist and proximal pole scaphoid fractures

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/j.rboe.2018.03.004 ◽

2018 ◽

Vol 53 (3) ◽

pp. 267-275

Author(s):

Antônio Lourenço Severo ◽

Rodrigo Cattani ◽

Filipe Nogueira Schmid ◽

Haiana Lopes Cavalheiro ◽

Deodato Narciso de Castro Neto ◽

...

Keyword(s):

Percutaneous Treatment ◽

Proximal Pole ◽

Scaphoid Fractures

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MRI Assessment of the Proximal Pole of the Scaphoid after Internal Fixation with a Titanium Alloy Herbert Screw

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0585 ◽

2001 ◽

Vol 26 (4) ◽

pp. 326-329 ◽

Cited By ~ 6

Author(s):

M. GANAPATHI ◽

R. SAVAGE ◽

A. R. JONES

Keyword(s):

Magnetic Resonance Imaging ◽

Titanium Alloy ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Proximal Pole ◽

Postoperative Magnetic Resonance Imaging ◽

Herbert Screw ◽

Scaphoid Fractures ◽

Magnetic Resonance Imaging Mri ◽

Marrow Signal

We report a series of scaphoid fractures fixed with titanium alloy Herbert screws in which postoperative Magnetic Resonance Imaging (MRI) was used to assess the marrow signal in the proximal pole of the scaphoid and thus detect the presence of avascular necrosis. The artefact produced by the titanium alloy Herbert screw did not preclude this assessment.

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Proximal Pole Scaphoid Fractures: A Computed Tomographic Assessment of Outcomes

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.10.013 ◽

2016 ◽

Vol 41 (1) ◽

pp. 54-58 ◽

Cited By ~ 16

Author(s):

Ruby Grewal ◽

Kristina Lutz ◽

Joy C. MacDermid ◽

Nina Suh

Keyword(s):

Proximal Pole ◽

Computed Tomographic ◽

Scaphoid Fractures

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Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures

Journal of Wrist Surgery ◽

10.1055/s-0038-1641716 ◽

2018 ◽

Vol 07 (04) ◽

pp. 350-354

Author(s):

Reinier Beks ◽

Tessa Drijkoningen ◽

Femke Claessen ◽

Thierry Guitton ◽

David Ring ◽

...

Keyword(s):

Interobserver Reliability ◽

Tertiary Hospital ◽

Adverse Outcomes ◽

Consecutive Series ◽

Proximal Pole ◽

Level Of Evidence ◽

Fracture Location ◽

Scaphoid Fractures ◽

Improve Reliability ◽

Control Study

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.

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Gadolinium Enhanced Mr Assessment of Proximal Fragment Vascularity in Nonunions after Scaphoid Fracture: Does It Predict the Outcome of Reconstructive Surgery?

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.03.012 ◽

2004 ◽

Vol 29 (5) ◽

pp. 444-448 ◽

Cited By ~ 41

Author(s):

A.K. SINGH ◽

T.R.C. DAVIS ◽

J.S. DAWSON ◽

J.A. ONI ◽

N.D. DOWNING

Keyword(s):

Internal Fixation ◽

Reconstructive Surgery ◽

Scaphoid Fracture ◽

Proximal Fragment ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Fracture Nonunion ◽

Fracture Nonunions ◽

Outcome Of Surgery ◽

Mr Scanning

This study investigated whether the outcome of bone graft and internal fixation surgery for nonunion of scaphoid fractures could be predicted by gadolinium-enhanced MR assessments of proximal fragment vascularity. Sixteen established scaphoid fracture nonunions underwent gadolinium-enhanced MR scanning before surgical treatment with bone grafting and internal fixation. No relationship was found between MR enhancement and the outcome of surgery. Union was achieved in eight of the 12 nonunions with more than 50% enhancement, and three of the four with less than 50% enhancement, of the proximal pole. Furthermore, union was achieved in both of the nonunions which had less than 25% enhancement of the proximal pole. We conclude that enhanced MR assessments of the vascularity of the proximal fragment of a scaphoid fracture nonunion do not accurately predict the outcome of reconstructive surgery.

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Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification

Journal of Wrist Surgery ◽

10.1055/s-0039-1692470 ◽

2019 ◽

Vol 08 (06) ◽

pp. 446-451

Author(s):

Tessa Drijkoningen ◽

Amin Mohamadi ◽

Wouter F. van Leeuwen ◽

Yonatan Schwarcz ◽

David Ring ◽

...

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Interobserver Reliability ◽

Scaphoid Fracture ◽

Fracture Classification ◽

Proximal Pole ◽

Level Of Evidence ◽

Related Factors ◽

Scaphoid Fractures ◽

Fracture Patterns

Abstract Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification (P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.

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