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Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration

BACKGROUND: Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically impor...

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Autores principales: Chammas, Pierre-Emmanuel, Pastor, Maxime, Chammas, Michel, Buijze, Geert Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635912/
https://www.ncbi.nlm.nih.gov/pubmed/37946093
http://dx.doi.org/10.1186/s10195-023-00735-1
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author Chammas, Pierre-Emmanuel
Pastor, Maxime
Chammas, Michel
Buijze, Geert Alexander
author_facet Chammas, Pierre-Emmanuel
Pastor, Maxime
Chammas, Michel
Buijze, Geert Alexander
author_sort Chammas, Pierre-Emmanuel
collection PubMed
description BACKGROUND: Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard. MATERIALS AND METHODS: Ten fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique). RESULTS: Standard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001). CONCLUSIONS: Standard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases. Level of Evidence Not applicable.
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spelling pubmed-106359122023-11-11 Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration Chammas, Pierre-Emmanuel Pastor, Maxime Chammas, Michel Buijze, Geert Alexander J Orthop Traumatol Original Article BACKGROUND: Articular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard. MATERIALS AND METHODS: Ten fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique). RESULTS: Standard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001). CONCLUSIONS: Standard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases. Level of Evidence Not applicable. Springer International Publishing 2023-11-09 2023-12 /pmc/articles/PMC10635912/ /pubmed/37946093 http://dx.doi.org/10.1186/s10195-023-00735-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Chammas, Pierre-Emmanuel
Pastor, Maxime
Chammas, Michel
Buijze, Geert Alexander
Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title_full Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title_fullStr Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title_full_unstemmed Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title_short Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
title_sort standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635912/
https://www.ncbi.nlm.nih.gov/pubmed/37946093
http://dx.doi.org/10.1186/s10195-023-00735-1
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