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Validity of computed tomography in predicting scaphoid screw prominence: a cadaveric study

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Abstract

Background

Studies of hardware protrusion into joint spaces following fracture fixation have been performed to address whether or not there is discrepancy between the actual and radiographic appearance of screw prominence. The purpose of our study was to prove that, with respect to the scaphoid, prominence as visualized on CT scan is real and not a result of metal artifact.

Methods

Forty-two cadaveric wrists were separated into four allotted groups with 21 control specimens and 21 study specimens. All specimens were radiographically screened to exclude those with inherent carpal abnormalities. Acutrak® headless compression screws were placed into all specimens using an open dorsal approach. Cartilage was removed from screw insertion site at the convex surface of the scaphoid proximal pole. Control specimens had 0 mm screw head prominence. The studied specimens had 1, 2, and 3 mm head prominence measured with a digital caliper. Computed tomography, with direct sagittal acquisition and metal suppression technique, was then performed on all specimens following screw placement. Two staff radiologists blinded to the study groups interpreted the images.

Results

Results revealed that only one of 21 control specimens was interpreted as prominent. Comparatively, in the studied groups, 90% were accurately interpreted as prominent.

Conclusions

CT provides an accurate assessment of scaphoid screw head prominence. When a screw appears prominent on CT scan, it is likely to be truly prominent without contribution from metallic artifact.

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Acknowledgements

We thank Ronald Rivenburgh, Chief Curator of the Uniformed Services University Cadaver Lab, for procuring and arranging for storage of the cadaveric specimens used in our study.

Funding

This project was supported in part by the Alpha Omega Alpha Carolyn L. Kucklein Student Research Fellowship.

Author information

Authors and Affiliations

  1. Captain James A. Lovell Federal Health Care Center, USS Tranquillity BHC 1007, 3001 Greenbay Road, North Chicago, IL, 60064, USA

    Clare E. Griffis

  2. Biostatistics Consulting Center, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Cara Olsen

  3. Walter Reed National Military Medical Center, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Leon Nesti

  4. Walter Reed National Military Medical Center, Uniformed Services University, 8901 Rockville Pike, Bethesda, MD, 20889, USA

    C. Frank Gould & Michael Frew

  5. Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Patricia McKay

  6. Orthopaedic Hand and Upper Extremity Surgery, Walter Reed National Military Medical Center, 8901, Rockville Pike, Bethesda, MD, 20889, USA

    Patricia McKay

  7. Kimbrough Ambulatory Care Center, Fort Meade, MD, USA

    Patricia McKay

Authors
  1. Clare E. Griffis
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  2. Cara Olsen
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  3. Leon Nesti
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  4. C. Frank Gould
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  5. Michael Frew
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  6. Patricia McKay
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Corresponding author

Correspondence to Clare E. Griffis.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Our study protocol was submitted to Walter Reed’s Institutional Review Board and was deemed waived based on the use of cadaveric tissue. See attached memorandum of IRB approval letter.

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Griffis, C.E., Olsen, C., Nesti, L. et al. Validity of computed tomography in predicting scaphoid screw prominence: a cadaveric study. Arch Orthop Trauma Surg 137, 573–577 (2017). https://doi.org/10.1007/s00402-017-2658-2

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  • DOI: https://doi.org/10.1007/s00402-017-2658-2

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