Our Summary

This research paper investigates the best way to fix a type of broken wrist bone (called the scaphoid) using screws. The researchers used 28 wrist bones from cadavers and created a standard fracture in each one. They then repaired each fracture with two screws, positioned either in line with the length of the bone (sagittal plane) or across the width of the bone (coronal plane). They used a 3D-printed device, designed specifically for each bone, to help place the screws accurately.

After fixing the fractures, the researchers then tested how much force it took to make the fracture fail again, how stiff the repair was, and how much energy it absorbed before failing. They found that the distance between screws was greater when they were placed in line with the length of the bone. However, there was no significant difference in the force required to make the fracture fail, stiffness, or energy absorption, regardless of whether the screws were positioned lengthwise or widthwise.

Therefore, the researchers concluded that, from a mechanical perspective, it doesn’t matter whether the screws are placed lengthwise or widthwise when fixing this type of broken wrist bone. This means that surgeons can choose to place the screws based on what is easiest for them and best suits the individual fracture.

FAQs

  1. What type of bone fracture did the researchers investigate in the study?
  2. Did the researchers find any significant difference in the force required to make the fracture fail, stiffness, or energy absorption based on the positioning of the screws?
  3. What was the conclusion of the study in terms of positioning of the screws for repairing a scaphoid fracture?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scaphoid fracture surgery is that the positioning of the screws used to repair the fracture (either in line with the length of the bone or across the width of the bone) does not significantly affect the outcome of the surgery in terms of stability and strength. This means that the surgeon can choose the screw placement that is easiest for them and best suits the individual fracture.

Suitable For

Patients who are typically recommended scaphoid fracture surgery are those with displaced fractures, fractures that are at risk for nonunion (failure of the bone to heal), fractures that are unstable, or fractures that involve the proximal pole of the scaphoid bone. In some cases, non-surgical treatment such as casting may be attempted first, but surgery may be necessary if the fracture does not heal properly or if there is significant displacement. Surgery is also recommended for patients with scaphoid fractures who have a high demand for wrist function, such as athletes or individuals with physically demanding jobs.

Timeline

Before scaphoid fracture surgery:

  1. Patient experiences pain, swelling, and limited range of motion in the wrist.
  2. Patient undergoes X-rays or other imaging tests to confirm the fracture.
  3. Patient may wear a splint or cast to immobilize the wrist while waiting for surgery.

After scaphoid fracture surgery:

  1. Patient undergoes surgery to fix the fracture with screws, either placed lengthwise or widthwise.
  2. Patient may need to wear a cast or splint for several weeks to allow the bone to heal.
  3. Patient undergoes physical therapy to regain strength and range of motion in the wrist.
  4. Follow-up appointments with the surgeon to monitor healing and remove any hardware if necessary.
  5. Patient gradually resumes normal activities and may require ongoing monitoring for any complications or long-term issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scaphoid fracture surgery include:

  1. What type of scaphoid fracture do I have, and why is surgery recommended for my specific case?
  2. What are the potential risks and complications associated with scaphoid fracture surgery?
  3. What is the success rate of scaphoid fracture surgery, and what is the typical recovery time?
  4. Will I need to wear a cast or splint after surgery, and for how long?
  5. What type of anesthesia will be used during the surgery, and what is the expected level of pain during the recovery process?
  6. How will the screws be positioned in my wrist during the surgery, and how will they help in the healing process?
  7. Will physical therapy be necessary after surgery, and when can I expect to regain full function and range of motion in my wrist?
  8. What is the long-term outlook for my wrist after scaphoid fracture surgery, and are there any lifestyle modifications I should consider to prevent future injuries?
  9. Are there any alternative treatment options available for my scaphoid fracture, and how do they compare to surgical intervention?
  10. How many scaphoid fracture surgeries have you performed, and what is your success rate with this procedure?

Reference

Authors: Surke C, Huntington LS, Zhang X, Ek ETH, Ackland D, Tham SK. Journal: J Hand Surg Am. 2022 Nov;47(11):1118.e1-1118.e8. doi: 10.1016/j.jhsa.2021.08.019. Epub 2021 Oct 22. PMID: 34690014