Screw fixation of scaphoid fractures

A biomechanical assessment of screw length and screw augmentation

Seth Dodds, Manohar M. Panjabi, Joseph F. Slade

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Purpose: To assess the biomechanical stability relative to screw length and K-wire augmentation in scaphoid fracture fixation using a flexibility testing protocol and cadaver scaphoids whose soft tissue attachments remained undisturbed. Our hypothesis was 2-fold: increasing screw length and augmenting fixation with a K-wire would improve fracture fragment stability, individually and in combination. Methods: Flexion and extension loading applied through wrist tendons was performed on 10 cadaveric wrists after volar wedge scaphoid osteotomy and internal fixation. Each wrist participated in 3 experimental groups: short screw, long screw, and long screw augmented with a K-wire transfixing the distal pole to the capitate. Interfragmentary displacements were measured. Results: Analysis of variance showed significantly less fracture fragment motion with longer screws than with short screws in 4 of the 6 displacement axes. The flexion/extension axis rotations for the short, long, and augmented long-screw groups were 8.2° ± 4.8°, 3.9° ± 1.6°, and 1.8° ± 1.3°, respectively. Although K-wire augmentation reduced displacement of the fracture fragments it did not decrease interfragmentary motion significantly when compared with the long-screw group. Conclusions: Under physiologically applied loading of cadaveric wrists with unstable scaphoid waist fractures the long screw provided significantly greater stability than the short screw. Although K-wire augmentation in the long-screw group did improve stability the improvements were not significant. Based in part on the biomechanical data from this study it is our recommendation that the optimally placed screw for scaphoid fracture fixation stability is a long screw positioned down the central axis of the scaphoid deep into subchondral bone.

Original languageEnglish (US)
Pages (from-to)405-413
Number of pages9
JournalJournal of Hand Surgery
Volume31
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

Fingerprint

Fracture Fixation
Wrist
Osteotomy
Cadaver
Tendons
Analysis of Variance
Bone and Bones

Keywords

  • Biomechanics
  • Fracture
  • Percutaneous
  • Scaphoid
  • Screw length
  • Stability
  • Wrist

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Screw fixation of scaphoid fractures : A biomechanical assessment of screw length and screw augmentation. / Dodds, Seth; Panjabi, Manohar M.; Slade, Joseph F.

In: Journal of Hand Surgery, Vol. 31, No. 3, 03.2006, p. 405-413.

Research output: Contribution to journalArticle

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abstract = "Purpose: To assess the biomechanical stability relative to screw length and K-wire augmentation in scaphoid fracture fixation using a flexibility testing protocol and cadaver scaphoids whose soft tissue attachments remained undisturbed. Our hypothesis was 2-fold: increasing screw length and augmenting fixation with a K-wire would improve fracture fragment stability, individually and in combination. Methods: Flexion and extension loading applied through wrist tendons was performed on 10 cadaveric wrists after volar wedge scaphoid osteotomy and internal fixation. Each wrist participated in 3 experimental groups: short screw, long screw, and long screw augmented with a K-wire transfixing the distal pole to the capitate. Interfragmentary displacements were measured. Results: Analysis of variance showed significantly less fracture fragment motion with longer screws than with short screws in 4 of the 6 displacement axes. The flexion/extension axis rotations for the short, long, and augmented long-screw groups were 8.2° ± 4.8°, 3.9° ± 1.6°, and 1.8° ± 1.3°, respectively. Although K-wire augmentation reduced displacement of the fracture fragments it did not decrease interfragmentary motion significantly when compared with the long-screw group. Conclusions: Under physiologically applied loading of cadaveric wrists with unstable scaphoid waist fractures the long screw provided significantly greater stability than the short screw. Although K-wire augmentation in the long-screw group did improve stability the improvements were not significant. Based in part on the biomechanical data from this study it is our recommendation that the optimally placed screw for scaphoid fracture fixation stability is a long screw positioned down the central axis of the scaphoid deep into subchondral bone.",
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