Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study.

Background: Recent reports on internal fixation of acute fractures of the scaphoid waist have demonstrated higher rates of central placement of the screw when cannulated screws were used than when noncannulated screws were used. This cadaveric study was designed to determine whether central placement in the proximal fragment of the scaphoid offers a biomechanical advantage.

Methods: Eleven matched pairs of scaphoids were removed from fresh cadaveric wrists. Each scaphoid was placed in a custom manufactured jig that was used to create reproducible central and eccentric positioning of the guidewire. Then a linear osteotomy was made followed by placement of a Herbert-Whipple cannulated screw to fix the osteotomy. The specimen was then potted in a holder with use of polymethylmethacrylate with a Kirschner wire passed through the proximal end of the scaphoid and placed into a fixture with a pneumatically driven plunger resting on the surface of the distal pole. The load acting through the plunger was measured with use of a load-cell, and its excursion was measured with use of a linear variable differential transformer. Stiffness, load at 2 mm of displacement, load at failure, and mechanism of failure were measured, and the two groups were compared with regard to stiffness and strength.

Results: Central placement of the screw in the proximal fragment of the scaphoid had superior results compared with those after eccentric positioning of the screw. Fixation with central placement of the screw demonstrated 43% greater stiffness (12.7 N per mm compared with 8.9 N per mm; p < 0.01), 113% greater load at 2 mm of displacement (126 N compared with 59.1 N; p < 0.01), and 39% greater load at failure (712 N compared with 513 N; p > 0.05).

Conclusions And Clinical Relevance: Central placement of the screw in the proximal fragment of the scaphoid offers a biomechanical advantage in the internal fixation of an osteotomy of the scaphoid waist. Clinical efforts and techniques that facilitate central placement of the screw in the fixation of fractures of the scaphoid waist should be encouraged.