Skip to main content
SpringerLink
Log in

Influence of Screw Design, Sex, and Approach in Scaphoid Fracture Fixation

  • Basic Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Screw fixation of scaphoid fractures has gained popularity. A long central screw has been shown to be biomechanically advantageous.

Questions/purposes

We compared the ability of different screw designs to obtain this goal and determined the influence of sex and approach on screw length.

Methods

We performed all measurements on three-dimensional reconstructions of 20 CT scans of normal scaphoids (10 men and 10 women) with the use of software. The three-dimensional computer models were analyzed, the central axis was defined, and the screws were placed along this axis. We compared 15 different available screw designs and volar and dorsal screw placement.

Results

The length of the scaphoid along its central axis was longer in men (mean, 27.14 mm; standard error of the mean, 0.97 mm) than in women (mean, 23.86 mm; standard error of the mean, 0.37 mm). The screw length that can be used was longer in the volar approach (mean, 23.72 mm; standard error of the mean, 0.19 mm) than in the dorsal approach (mean, 23.31 mm; standard error of the mean, 0.19 mm) regardless of the screw design. Screws with a trailing thread diameter greater than 3.9 mm and leading thread diameter greater than 3.0 mm were shorter.

Conclusions

Scaphoids in women are smaller than in men. Theoretically, fixation of scaphoid fractures through a volar approach will allow the surgeon to use longer screws. The screw design has a significant influence on the screw length that can be used in scaphoid fracture fixation. We recommend using a differential pitch screw with a thread diameter of 3.9 mm or less.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–D
Fig. 2
Fig. 3A–D
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Adamany DC, Mikola EA, Fraser BJ. Percutaneous fixation of the scaphoid through a dorsal approach: an anatomic study. J Hand Surg Am. 2008;33:327–331.

    Article  PubMed  Google Scholar 

  2. Adams BD, Blair WF, Reagan DS, Grundberg AB. Technical factors related to Herbert screw fixation. J Hand Surg Am. 1988;13:893–899.

    Article  PubMed  CAS  Google Scholar 

  3. Adolfsson L, Lindau T, Arner M. Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg Br. 2001;26:192–195.

    Article  PubMed  CAS  Google Scholar 

  4. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg Am. 1989;14:679–687.

    Article  PubMed  CAS  Google Scholar 

  5. Arora R, Gschwentner M, Krappinger D, Lutz M, Blauth M, Gabl M. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg. 2007;127:39–46.

    Article  PubMed  CAS  Google Scholar 

  6. Bedi A, Jebson PJ, Hayden RJ, Jacobson JA, Martus JE. Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach: an assessment of radiographic and functional outcomes. J Hand Surg Am. 2007;32:326–333.

    Article  PubMed  Google Scholar 

  7. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.

    Article  PubMed  CAS  Google Scholar 

  8. Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am. 2001;83:483–488.

    PubMed  Google Scholar 

  9. Botte MJ, Gelberman RH. Modified technique for Herbert screw insertion in fractures of the scaphoid. J Hand Surg Am. 1987;12:149–150.

    Article  PubMed  CAS  Google Scholar 

  10. Bushnell BD, McWilliams AD, Messer TM. Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. J Hand Surg Am. 2007;32:827–833.

    Article  PubMed  Google Scholar 

  11. Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am. 2004;29:74–79.

    Article  PubMed  Google Scholar 

  12. Compson JP, Waterman JK, Heatley FW. The radiological anatomy of the scaphoid. Part 1: Osteology. J Hand Surg Br. 1994;19:183–187.

    Article  PubMed  CAS  Google Scholar 

  13. Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am. 2005;87:2160–2168.

    Article  PubMed  CAS  Google Scholar 

  14. Dodds SD, Panjabi MM, Slade JF 3rd. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am. 2006;31:405–413.

    Article  PubMed  Google Scholar 

  15. Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br. 1996;78:519–529.

    PubMed  CAS  Google Scholar 

  16. Ford DJ, Khoury G, el-Hadidi S, Lunn PG, Burke FD. The Herbert screw for fractures of the scaphoid: a review of results and technical difficulties. J Bone Joint Surg Br. 1987;69:124–127.

    PubMed  CAS  Google Scholar 

  17. Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation: a pilot study. J Bone Joint Surg Br. 1998;80:95–99.

    Article  PubMed  CAS  Google Scholar 

  18. Haisman JM, Rohde RS, Weiland AJ; American Academy of Orthopaedic Surgeons. Acute fractures of the scaphoid. J Bone Joint Surg Am. 2006;88:2750–2758.

    PubMed  Google Scholar 

  19. Heinzelmann AD, Archer G, Bindra RR. Anthropometry of the human scaphoid. J Hand Surg Am. 2007;32:1005–1008.

    Article  PubMed  Google Scholar 

  20. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66:114–123.

    PubMed  CAS  Google Scholar 

  21. Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg. 1999;33:423–426.

    Article  PubMed  CAS  Google Scholar 

  22. Jeon IH, Micic ID, Oh CW, Park BC, Kim PT. Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches. J Hand Surg Am. 2009;34:228–236.e1.

    Article  PubMed  Google Scholar 

  23. Jiranek WA, Ruby LK, Millender LB, Bankoff MS, Newberg AH. Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid. J Bone Joint Surg Am. 1992;74:1217–1228.

    PubMed  CAS  Google Scholar 

  24. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.

    Article  PubMed  CAS  Google Scholar 

  25. Larsen CF, Brøndum V, Skov O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand. 1992;63:216–218.

    Article  PubMed  CAS  Google Scholar 

  26. Leventhal EL, Wolfe SW, Walsh EF, Crisco JJ. A computational approach to the “optimal” screw axis location and orientation in the scaphoid bone. J Hand Surg Am. 2009;34:677–684.

    Article  PubMed  Google Scholar 

  27. Levitz S, Ring D. Retrograde (volar) scaphoid screw insertion: a quantitative computed tomographic analysis. J Hand Surg Am. 2005;30:543–548.

    Article  PubMed  Google Scholar 

  28. Luria S, Hoch S, Liebergall M, Mosheiff R, Peleg E. Optimal fixation of acute scaphoid fractures: finite element analysis. J Hand Surg Am. 2010;35:1246–1250.

    Article  PubMed  Google Scholar 

  29. Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am. 1984;66:504–509.

    PubMed  CAS  Google Scholar 

  30. McCallister WV, Knight J, Kaliappan R, Trumble TE. Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study. J Bone Joint Surg Am. 2003;85:72–77.

    PubMed  Google Scholar 

  31. McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br. 2008;90:66–71.

    Article  PubMed  CAS  Google Scholar 

  32. Meermans G, Verstreken F. Percutaneous transtrapezial fixation of acute scaphoid fractures. J Hand Surg Eur. 2008;33:791–796.

    Article  CAS  Google Scholar 

  33. Meermans G, Verstreken F. A comparison of 2 methods for scaphoid central screw placement from a volar approach. J Hand Surg Am. 2011;36:1669–1674.

    Article  PubMed  Google Scholar 

  34. Menapace KA, Larabee L, Arnoczky SP, Neginhal VS, Dass AG, Ross LM. Anatomic placement of the Herbert-Whipple screw in scaphoid fractures: a cadaver study. J Hand Surg Am. 2001;26:883–892.

    Article  PubMed  CAS  Google Scholar 

  35. Pring DJ, Hartley EB, Williams DJ. Scaphoid osteosynthesis: early experience with the Herbert bone screw. J Hand Surg Br. 1987;12:46–49.

    Article  PubMed  CAS  Google Scholar 

  36. Radford PJ, Matthewson MH, Meggitt BF. The Herbert screw for delayed and non-union of scaphoid fractures: a review of fifty cases. J Hand Surg Br. 1990;15:455–459.

    Article  PubMed  CAS  Google Scholar 

  37. Soubeyrand M, Biau D, Mansour C, Mahjoub S, Molina V, Gagey O. Comparison of percutaneous dorsal versus volar fixation of scaphoid waist fractures using a computer model in cadavers. J Hand Surg Am. 2009;34:1838–1844.

    Article  PubMed  Google Scholar 

  38. Stark HH, Rickard TA, Zemel NP, Ashworth CR. Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation. J Bone Joint Surg Am. 1988;70:982–991.

    PubMed  CAS  Google Scholar 

  39. Toby EB, Butler TE, McCormack TJ, Jayaraman G. A comparison of fixation screws for the scaphoid during application of cyclical bending loads. J Bone Joint Surg Am. 1997;79:1190–1197.

    PubMed  CAS  Google Scholar 

  40. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid: treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am. 1996;78:1829–1837.

    PubMed  CAS  Google Scholar 

  41. Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV. Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am. 2000;82:633–641.

    PubMed  CAS  Google Scholar 

  42. Walsh E, Crisco JJ, Wolfe SW. Computer-assisted navigation of volar percutaneous scaphoid placement. J Hand Surg Am. 2009;34:1722–1728.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lievensberg Hospital, Bergen Op Zoom, The Netherlands

    Geert Meermans MD

  2. Marie-Josélaan 19, 2600, Berchem, Belgium

    Geert Meermans MD

  3. Monica Hospital, Deurne, Belgium

    Frederik Verstreken MD

Authors
  1. Geert Meermans MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frederik Verstreken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geert Meermans MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Monica Hospital, Deurne, Belgium.

About this article

Cite this article

Meermans, G., Verstreken, F. Influence of Screw Design, Sex, and Approach in Scaphoid Fracture Fixation. Clin Orthop Relat Res 470, 1673–1681 (2012). https://doi.org/10.1007/s11999-011-2218-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2218-y

Keywords

Search

Navigation