scholarly journals Proximal Pole Scaphoid Fractures: A Computed Tomographic Assessment of Outcomes

2016 ◽  
Vol 41 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Ruby Grewal ◽  
Kristina Lutz ◽  
Joy C. MacDermid ◽  
Nina Suh
Keyword(s):  
Proximal Pole ◽  
Computed Tomographic ◽  
Scaphoid Fractures

DORSAL OPEN REPAIR OF PROXIMAL POLE SCAPHOID FRACTURES

Hand Clinics ◽  
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

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

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.

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

2017 ◽  
Vol 43 (1) ◽  
pp. 73-79 ◽  
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.

Hamate to Scaphoid Transfer for Nonreconstructable Proximal Pole Scaphoid Fractures

2021 ◽  
pp. 555-559
Author(s):  
Joshua A. Gillis ◽  
Bassem T. Elhassan ◽  
Sanjeev Kakar
Keyword(s):  
Proximal Pole ◽  
Scaphoid Fractures

scholarly journals Success of scaphoid nonunion surgery is independent of proximal pole vascularity

2017 ◽  
Vol 43 (1) ◽  
pp. 32-40 ◽  
Author(s):  
Schneider K. Rancy ◽  
Morgan M. Swanstrom ◽  
Edward F. DiCarlo ◽  
Darryl B. Sneag ◽  
Steve K. Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Histopathological Analysis ◽  
Resonance Imaging ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Intraoperative Bleeding ◽  
Tomographic Images ◽  
Computed Tomographic ◽  
Prospective Longitudinal

We followed 35 consecutive patients with scaphoid nonunions in a prospective longitudinal registry. All nonunions were treated with curettage, non-vascularized autogenous grafting and headless screw fixation. Preoperative magnetic resonance imaging, intraoperative bleeding points and histopathological analysis of cancellous bone in the proximal pole were recorded as measures of viability. Healing was categorized as ≥50% bony bridging on computed tomographic images in the plane of the scaphoid. Nine of 23 proximal poles demonstrated ischaemia on magnetic resonance imaging but none were interpreted as infarcted. Twenty-eight of 33 were found to have impaired vascularity as assessed by intraoperative bleeding. Fourteen of 32 demonstrated ≥50% trabecular necrosis and four of 33 demonstrated ≥50% tissue necrosis on histopathological analysis. Thirty of 33 demonstrated focal or robust remodelling activity. Despite pathological evidence of impaired vascularity in over half of the patients, 33 of the 35 scaphoids had healed by 12 weeks. We conclude that proximal pole infarction is decidedly rare and that vascularized bone grafting is seldom required. Level of evidence: IV

scholarly journals Percutaneous treatment for waist and proximal pole scaphoid fractures

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

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

2001 ◽  
Vol 26 (4) ◽  
pp. 326-329 ◽  
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.

scholarly journals Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures

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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