Abstract
Background
The scaphotrapeziotrapezoid joint (STTJ) has a complex osseous and ligamentous anatomy. Precise radiographic assessment is paramount when assessing osteoarthritic, post-traumatic, or post-operative patients. There has been no described technique to image the STTJ without any wrist movement, unobscured by the rest of the carpus. The aim of this study was to define an optimal radiographic method to assess the STTJ while maintaining the wrist in neutral position.
Methods
Computer tomography 3-D reconstructions of three uninjured wrists were initially used to determine an approximate beam angle. Serial radiographs of 12 cadaveric wrists were taken. The forearms were positioned in varying degrees of pronation and supination. The beam angle was concurrently adjusted to varying degrees of caudal tilt. From the images obtained, we assessed if the adjacent carpus obscured the view of the STTJ.
Results
Optimal STTJ imaging was in the semi-pronated wrist position with the X-ray beam tilted caudal. We found that the STTJ was best visualized at 48° supination from a fully pronated wrist and a caudal beam angle of 22°.
Conclusions
The described wrist and beam orientation can aid in achieving an unobstructed view of the STTJ with little technical effort. This can aid in imaging ambulatory patients where symptoms prevent using other imaging techniques as well as patients in the operating room where imaging timing can be critical.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fogg QA. Scaphoid variation and an anatomical basis for variable carpal mechanics [Ph.D thesis]. Adelaide: The University of Adelaide; 2004.
Feipel V, Rinnen D, Rooze M. Postero-anterior radiography of the wrist: scapholunate ratios and joint projection shape analysis. Surg Radiol Anat. 1999;21(3):207–13.
Wollstein R, Wandzy N, Mastella DJ, Carlson L, Watson HK. A radiographic view of the scaphotrapezium-trapezoid joint. J Hand Surg Am. 2005;30(6):1161–3.
Geurts G, van Riet R, Meermans G, Verstreken F. Incidence of scaphotrapezial arthritis following volar percutaneous fixation of nondisplaced scaphoid waist fractures using a transtrapezial approach. J Hand Surg Am. 2011;36(11):1753–8.
Melville DM, Taljanovic MS, Scalcione LR, Eble JM, Gimber LH, DeSilva GL, et al. Imaging and management of thumb carpometacarpal joint osteoarthritis. Skelet Radiol. 2015;44(2):165–77.
Scordino LE, Bernstein J, Nakashian M, McIntosh M, Cote MP, Rodner CM, et al. Radiographic prevalence of scaphotrapeziotrapezoid osteoarthrosis. J Hand Surg Am. 2014;39(9):1677–82.
Brown GD 3rd, Roh MS, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. J Hand Surg Am. 2003;28(5):739–43.
Moritomo H, Viegas SF, Nakamura K, Dasilva MF, Patterson RM. The scaphotrapezio-trapezoidal joint. Part 1: an anatomic and radiographic study. J Hand Surg Am. 2000;25(5):899–910.
International Wrist Investigator’s Workshop Terminology C. Wrist: terminology and definitions. J Bone Joint Surg Am. 2002;84(A Suppl 1):1–73.
DeGeorge BR Jr, Pulos N, Shin AY. Obtaining a reliable scaphotrapeziotrapezoid radiograph: pronation, ulnar deviation, and thumb abduction. Tech Hand Up Extrem Surg. 2018;22(3):120–3.
Whitley AS, Sloane C, Hoadley G, Jefferson G, Anderson C, Holmes K. Clark's positioning in radiography. Thirteenth edition. Ed. Boca Raton: CRC Press; 2016.
Crosby EB, Linscheid RL, Dobyns JH. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am. 1978;3(3):223–34.
Srinivasan VB, Matthews JP. Results of scaphotrapeziotrapezoid fusion for isolated idiopathic arthritis. J Hand Surg Br. 1996;21(3):378–80.
Wollstein R, Watson HK. Scaphotrapeziotrapezoid arthrodesis for arthritis. Hand Clin. 2005;21(4):539–43 vi.
Barton NJ. The late consequences of scaphoid fractures. J Bone Joint Surg Br. 2004;86(5):626–30.
Kehoe NJ, Hackney RG, Barton NJ. Incidence of osteoarthritis in the scapho-trapezial joint after Herbert screw fixation of the scaphoid. J Hand Surg Br. 2003;28(5):496–9.
Dodds SD, Patterson JT, Halim A. Volar plate fixation of recalcitrant scaphoid nonunions with volar carpal artery vascularized bone graft. Techniq Hand Upper Extrem Surg. 2014;18(1):2–7.
Leixnering M, Pezzei C, Weninger P, Mayer M, Bogner R, Lederer S, et al. First experiences with a new adjustable plate for osteosynthesis of scaphoid nonunions. J Trauma. 2011;71(4):933–8.
Bain GI, Turow A, Phadnis J. Dorsal plating of unstable scaphoid fractures and nonunions. Tech Hand Up Extrem Surg. 2015;19(3):95–100.
Acknowledgements
The authors thank the Department for Anatomy & Histology at Flinders University of South Australia for providing the cadavers, in particular Prof. Rainer Haberberger and Gregory Souter for their continued support of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Turow, A., Phadnis, J. & Bain, G.I. A new radiographic view of the scaphotrapeziotrapezoid joint—a cadaveric study. Skeletal Radiol 48, 1899–1904 (2019). https://doi.org/10.1007/s00256-019-03222-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-019-03222-z