Minimally Invasive Fixation of Ultra-Small Proximal Pole Scaphoid Fractures

This study compares the direct and indirect costs of conservative and minimally invasive treatment for undisplaced scaphoid fractures. Costs data concerning groups of non-operated and operated patients were analysed. Direct costs were higher in operated patients. Although highly variable, indirect costs were significantly smaller in operated patients and the total costs were higher in nonoperated patients. In conclusion, operative treatment of scaphoid fractures is initially more expensive than conservative treatment but markedly decreases the work compensation costs.

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DORSAL OPEN REPAIR OF PROXIMAL POLE SCAPHOID FRACTURES

Hand Clinics ◽

10.1016/s0749-0712(21)01444-x ◽

2001 ◽

Vol 17 (4) ◽

pp. 601-610

Author(s):

Keith B. Raskin ◽

Debra Parisi ◽

Janet Baker ◽

Michael E. Rettig

Keyword(s):

Open Repair ◽

Proximal Pole ◽

Scaphoid Fractures

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Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Journal of Wrist Surgery ◽

10.1055/s-0040-1701512 ◽

2020 ◽

Vol 09 (03) ◽

pp. 203-208

Author(s):

Kristin E. Shoji ◽

F. Joseph Simeone ◽

Sezai Ozkan ◽

Chaitanya S. Mudgal

Keyword(s):

Bone Graft ◽

Common Mechanism ◽

Study Cohort ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Local Bone ◽

Case Series Study ◽

Increased Risk ◽

Surgical Fixation ◽

The Mean

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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Minimally invasive fixation with modified palm tree technique for proximal humerus fractures: Outcomes in a series of 132 patients

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.01.010 ◽

2021 ◽

Vol 17 ◽

pp. 11-17

Author(s):

Andreas Leonidou ◽

Siddharth Virani ◽

Georgios Panagopoulos ◽

Giuseppe Sforza ◽

Ehud Atoun ◽

...

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Palm Tree ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Minimally Invasive Fixation

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Minimally Invasive Fixation of Displaced Midclavicular Fractures With Titanium Elastic Nails

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e3181b8ba33 ◽

2010 ◽

Vol 24 (4) ◽

pp. 217-223 ◽

Cited By ~ 30

Author(s):

Ping-Cheng Liu ◽

Song-Hsiung Chien ◽

Jian-Chih Chen ◽

Chih-Hsin Hsieh ◽

Pei-His Chou ◽

...

Keyword(s):

Minimally Invasive ◽

Elastic Nails ◽

Minimally Invasive Fixation

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Minimally Invasive Fixation of a Lateral Tibial Plateau Fracture in a Dog

10.1055/s-0040-1714960 ◽

2020 ◽

Author(s):

Peterson LC ◽

Kim SE

Keyword(s):

Minimally Invasive ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Lateral Tibial Plateau ◽

Plateau Fracture ◽

Minimally Invasive Fixation

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Minimally invasive fixation of intra-articular calcaneus fracture using sinus tarsi approach

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i4h.2382 ◽

2020 ◽

Vol 6 (4) ◽

pp. 526-528

Author(s):

Dr. Sunil G Kulkarni ◽

Dr. Vijay Dattu ◽

Dr. Nikhil Lambat ◽

Dr. Shrinivas Jadhav ◽

Dr. Tejas Patil ◽

...

Keyword(s):

Minimally Invasive ◽

Calcaneus Fracture ◽

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Minimally Invasive Fixation

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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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