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Three-Dimensional Analysis of Acute Scaphoid Fracture Displacement
Shai Luria, MD1; Yael Schwarcz, MD1; Eran Peleg, PhD1; Leo Joskowicz, PhD2; Ronit Wollstein, MD3; Yonatan Schwarcz, MD1
1Orthropaedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 2School of Engineering and Computer Science, The Hebrew University, Jerusalem, Israel; 3Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA

Introduction: Scaphoid fractures are common, and internal fixation is the preferred treatment for displaced fractures. Quantification of the mode of displacement of the scaphoid fragments may aid in correct surgical management. Previous studies have described the relative movement between the scaphoid fragments in fractures with nonunion. The goal of this study was to analyze the movement of acute scaphoid fracture fragments and adjacent bones relative to a common coordinate system.

Methods: All CT scans diagnosed with an acute scaphoid waist fracture during the study period were evaluated using the developed 3 model (Amira Dev 5.3, Mercury Computer Systems, Chelmsford, MA). The fractures were divided into displaced and nondisplaced fracture groups and were compared to a control group with no injury. Three anatomical landmarks were labeled on each of the distal and proximal fragments of the scaphoid as well as the lunate and trapezium. Four landmarks were marked on the distal radius articular surface. Each set of labels formed a triangle representing the bone or fragment. Virtual reduction of the fracture was conducted in the displaced fractures. A coordinate system based on the radius distal articular surface was used as reference. The position of each bone or fragment was calculated, using 6 variables, representing lateral, volar and distal motion; pronation, flexion/radial deviation, and rotation of the bone or fragment.

Results: In the displaced group, compared with nondisplaced and control groups, the proximal scaphoid fragment showed significant extension (25.1 and 25.2; p<0.001), supination (7.1 and 7.5; p=0.006) and volar motion (0.9 and 0.6 mm; p=0.037). The lunate showed supination (4.6 and 5.2; p=0.058), similar to that of the proximal scaphoid fragment. The distal fragment and the trapezium showed no movement.

Conclusion: Measuring the displacement of the acute scaphoid fracture fragments and the adjacent bones relative to a common coordinate system revealed that the proximal scaphoid fragment is the one displaced, along with supination of the lunate. According to this data, concurrent reduction of the proximal scaphoid and lunate may be the more effective reduction maneuver.

The developed 3D method can be a tool in the evaluation of the quality of reduction of the scaphoid fracture as well as other aspects of wrist biomechanics.

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