Purpose
High bone density and quality is associated with improved screw fixation in fracture
fixation. The objective of this study was to assess bone density and quality in the
proximal and distal scaphoid to determine optimum sites for placement of 2 screws
in scaphoid fracture fixation.
Methods
Twenty-nine cadaveric human scaphoid specimens were harvested and scanned using micro–computed
tomography. Bone density (bone volume fraction) and bone quality (relative bone surface
area, trabecular number, and trabecular thickness) were evaluated in 4 quadrants within
each of the proximal and distal scaphoid.
Results
The proximal radial quadrant of the scaphoid had significantly greater bone volume
than the distal ulnar (mean difference, 33.2%) and distal volar quadrants (mean difference,
32.3%). There was a significantly greater trabecular number in the proximal radial
quadrant than in the distal ulnar (mean difference, 16.7%) and in the distal volar
quadrants (mean difference, 15.9%) and between the proximal ulnar and the distal ulnar
quadrants (mean difference, 12%). There was a significantly greater bone surface area
in the proximal radial and distal radial quadrants than in the distal ulnar and distal
volar quadrants. There were no significant differences in trabecular thickness between
the 8 analyzed quadrants
Conclusions
Although there are differences in bone volume, trabecular number, and bone surface
area between the proximal pole of the scaphoid and that of the distal pole, there
were no significant differences in the bone quality (trabecular thickness, trabecular
number, and relative bone surface area) and density (bone volume fraction) between
the 4 quadrants of the proximal or distal pole of the cadaveric scaphoids studied.
Clinical relevance
Insertion of 2 headless compression screws can be determined by ease of surgical access
and ease of screw positioning and not by differences in bone quality or density of
the proximal or distal scaphoid.
Key words
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Article info
Publication history
Published online: July 25, 2020
Accepted:
May 27,
2020
Received:
May 5,
2019
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
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
