Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation.
OBJECTIVE
To assess the biomechanical stability relative to screw length and K-wire augmentation in scaphoid fracture fixation using a flexibility testing protocol and cadaver scaphoids whose soft tissue attachments remained undisturbed. Our hypothesis was 2-fold: increasing screw length and augmenting fixation with a K-wire would improve fracture fragment stability, individually and in combination.


METHODS
Flexion and extension loading applied through wrist tendons was performed on 10 cadaveric wrists after volar wedge scaphoid osteotomy and internal fixation. Each wrist participated in 3 experimental groups: short screw, long screw, and long screw augmented with a K-wire transfixing the distal pole to the capitate. Interfragmentary displacements were measured.


RESULTS
Analysis of variance showed significantly less fracture fragment motion with longer screws than with short screws in 4 of the 6 displacement axes. The flexion/extension axis rotations for the short, long, and augmented long-screw groups were 8.2 degrees +/- 4.8 degrees, 3.9 degrees +/- 1.6 degrees, and 1.8 degrees +/- 1.3 degrees, respectively. Although K-wire augmentation reduced displacement of the fracture fragments it did not decrease interfragmentary motion significantly when compared with the long-screw group.


CONCLUSIONS
Under physiologically applied loading of cadaveric wrists with unstable scaphoid waist fractures the long screw provided significantly greater stability than the short screw. Although K-wire augmentation in the long-screw group did improve stability the improvements were not significant. Based in part on the biomechanical data from this study it is our recommendation that the optimally placed screw for scaphoid fracture fixation stability is a long screw positioned down the central axis of the scaphoid deep into subchondral bone.
Dodds
Seth D
SD
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520, USA. sddodds@yahoo.com
Panjabi
Manohar M
MM
Slade
Joseph F
JF
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D001864:Bone Wires; D002102:Cadaver; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D008297:Male; D010027:Osteotomy; D011403:Pronation / Q000502:physiology; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D021361:Scaphoid Bone / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D013484:Supination / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery