Purpose
The purpose of this study was to investigate the intraosseous vascular anatomy of
the scaphoid using recent advances in micro–computed tomography (micro-CT) imaging
and 3-dimensional reconstruction. We also studied the effect of scaphoid shape and
screw position on the intraosseous vascular structure.
Methods
Thirteen upper extremities were injected with a contrast agent. The scaphoid bones
were extracted and scanned using a micro-CT scanner. The vascular impact of screw
insertion at various axes through the scaphoid was calculated and compared using the
generated 3-dimensional models. The specimens were 3-dimensionally–printed and the
morphology was assessed according to bone dimensions. A relationship between the internal
vascular patterns and these morphological features was determined.
Results
All specimens received vascular inflow from the dorsal ridge forming a vascular network
that supplied an average of 83% of the bone’s volume. This network was supplemented
in 4 specimens with volar vessels entering at the waist. Another network was identified,
created by vessels entering volarly at the tubercle, which supplied the remainder
of the scaphoid. One specimen did not receive any vessels at the tubercle. With regards
to screw placement, screws placed in the central axis were the least disruptive to
the internal vascularity, followed by the antegrade (dorsal) insertion axis. Two morphological
bone types were identified: type I or full scaphoids and type II or slender scaphoids.
Type I possessed a more robust internal vascular network than type II scaphoids.
Conclusions
This study identifies 2 distinct types of scaphoid morphology with 1 of them having
a less robust blood supply, which may prove to be related to development of nonunion,
avascular necrosis, or Preiser disease. Central axis and antegrade (dorsal) screw
fixation may be least disruptive to the internal blood supply.
Clinical relevance
Safer fixation of the scaphoid bone may be achieved by knowledge of intraosseous vascular
patterns.
Key words
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Article info
Publication history
Published online: September 19, 2019
Accepted:
August 2,
2019
Received:
November 17,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
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