Stephanie A Kwan, Tiffany N Bridges, Levi Buchan, Ashkan Sedigh, Justin M Kistler, Rick Tosti, Amir R Kachooei, Michael Rivlin
{"title":"单无头加压螺钉固定舟状骨腰骨折的生物力学稳定性。","authors":"Stephanie A Kwan, Tiffany N Bridges, Levi Buchan, Ashkan Sedigh, Justin M Kistler, Rick Tosti, Amir R Kachooei, Michael Rivlin","doi":"10.5435/JAAOS-D-24-00348","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures.</p><p><strong>Questions/purposes: </strong>(1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation?</p><p><strong>Methods: </strong>In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist. To determine whether rotation was present between the proximal and distal poles, radiographs of the wrist at terminal range of motion (ROM) were reviewed for relative change in wire position. The fracture was then reduced, and an HCS was then advanced across the fracture; rotation was again evaluated. Rotation was quantified in the group without fixation using a sensor that measured angular rotation.</p><p><strong>Results: </strong>Before screw fixation, interfragmentary rotation was found to average 22.5° during flexion/extension, 19.0° during pronation/supination, and 34.0° during radial/ulnar deviation around the central axis. The radiographs after osteotomy demonstrated rotation in all specimens. After fixation with an HCS, radiographs demonstrated relative rotation of the two halves of the scaphoid in all ROMs for all specimens, except flexion for one specimen.</p><p><strong>Discussion: </strong>Internal angular tension was observed within the scaphoid, and rotation of 20° to 30° was noted around the central axis during simulated ROM mimicking nonsurgical treatment. A single HCS failed to prevent fragment-relative rotation at the fracture site.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Biomechanical Stability of a Single Headless Compression Screw Construct to Fix Scaphoid Waist Fractures.\",\"authors\":\"Stephanie A Kwan, Tiffany N Bridges, Levi Buchan, Ashkan Sedigh, Justin M Kistler, Rick Tosti, Amir R Kachooei, Michael Rivlin\",\"doi\":\"10.5435/JAAOS-D-24-00348\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures.</p><p><strong>Questions/purposes: </strong>(1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation?</p><p><strong>Methods: </strong>In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist. To determine whether rotation was present between the proximal and distal poles, radiographs of the wrist at terminal range of motion (ROM) were reviewed for relative change in wire position. The fracture was then reduced, and an HCS was then advanced across the fracture; rotation was again evaluated. Rotation was quantified in the group without fixation using a sensor that measured angular rotation.</p><p><strong>Results: </strong>Before screw fixation, interfragmentary rotation was found to average 22.5° during flexion/extension, 19.0° during pronation/supination, and 34.0° during radial/ulnar deviation around the central axis. The radiographs after osteotomy demonstrated rotation in all specimens. After fixation with an HCS, radiographs demonstrated relative rotation of the two halves of the scaphoid in all ROMs for all specimens, except flexion for one specimen.</p><p><strong>Discussion: </strong>Internal angular tension was observed within the scaphoid, and rotation of 20° to 30° was noted around the central axis during simulated ROM mimicking nonsurgical treatment. A single HCS failed to prevent fragment-relative rotation at the fracture site.</p>\",\"PeriodicalId\":51098,\"journal\":{\"name\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-02-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5435/JAAOS-D-24-00348\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-00348","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
The Biomechanical Stability of a Single Headless Compression Screw Construct to Fix Scaphoid Waist Fractures.
Background: Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures.
Questions/purposes: (1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation?
Methods: In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist. To determine whether rotation was present between the proximal and distal poles, radiographs of the wrist at terminal range of motion (ROM) were reviewed for relative change in wire position. The fracture was then reduced, and an HCS was then advanced across the fracture; rotation was again evaluated. Rotation was quantified in the group without fixation using a sensor that measured angular rotation.
Results: Before screw fixation, interfragmentary rotation was found to average 22.5° during flexion/extension, 19.0° during pronation/supination, and 34.0° during radial/ulnar deviation around the central axis. The radiographs after osteotomy demonstrated rotation in all specimens. After fixation with an HCS, radiographs demonstrated relative rotation of the two halves of the scaphoid in all ROMs for all specimens, except flexion for one specimen.
Discussion: Internal angular tension was observed within the scaphoid, and rotation of 20° to 30° was noted around the central axis during simulated ROM mimicking nonsurgical treatment. A single HCS failed to prevent fragment-relative rotation at the fracture site.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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