Computer-Assisted Percutaneous Scaphoid Fixation: Concepts and Evolution

Abstract

Background?The treatment for undisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. Percutaneous fixation reduces some of the risks of open surgery, but can be technically demanding and carries the risk of radiation exposure. Recently, computer-assisted percutaneous scaphoid fixation (CAPSF) has been gaining interest. Materials and Methods?Conventional percutaneous scaphoid fixation is performed under fluoroscopic guidance and involves insertion of a guide wire along the length of the scaphoid to facilitate placement of a cannulated screw. Adapting computer-assisted techniques for scaphoid fixation poses several unique challenges including patient tracking and registration. Results?To date, five groups have successfully implemented systems for CAPSF. These systems have implemented wrist immobilization strategies to resolve the issue of patient tracking and have developed unique guidance techniques incorporating 2D fluoroscope, cone-beam CT, and ultrasound, to circumvent patient-based registration. Conclusions?Computer-aided percutaneous pinning of scaphoid waist fractures can significantly reduce radiation exposure and has the potential to improve the accuracy of this procedure. This article reviews the rationale for, and the evolution of, CAPSF and describes the key principles of computer-assisted technology.

Three-Dimensional Printed Targeting Device for Scaphoid Fracture Fixation

“…21-24 Due to the complex anatomy of the scaphoid, guide wire insertion can be challenging and often requires multiple attempts with significant radiation exposure to the surgeon. 11-13 Our targeting device enables accurate K-wire placement in a single attempt with no radiation exposure to the surgeon and reduced operative time. While our technique does require radiation exposure to the patient from a preoperative CT scan, many patients undergo advanced imaging during routine evaluation of this injury.…”

“…Image-guided navigation has successfully reduced intraoperative radiation exposure in other orthopedic procedures, and our procedure has the potential to avoid any radiation exposure to the surgical staff. 13,29 Our procedure can drastically reduce operative time as it requires a single insertion attempt and no fluoroscopy use. Additionally, as more procedures are performed using the wide-awake local anesthesia no tourniquet technique, our CT-guided procedure may allow scaphoid fracture fixation to be performed in the office setting under local anesthesia.…”

“…Commercial navigation systems have been successfully implemented in spine and joint replacement surgery, with improved accuracy and reduced radiation exposure. 13 Several groups have described the use of computer-assisted navigation in scaphoid screw placement, with some also using a targeting device. 13-19 While multiple cadaveric studies have demonstrated acceptable accuracy and low radiation exposure with navigation assistance, most did not show improvements in overall surgical time relative to traditional techniques.…”

“…13 Several groups have described the use of computer-assisted navigation in scaphoid screw placement, with some also using a targeting device. 13-19 While multiple cadaveric studies have demonstrated acceptable accuracy and low radiation exposure with navigation assistance, most did not show improvements in overall surgical time relative to traditional techniques. 14-17,19 Yin et al 18 described a percutaneous technique using a 3D printed guide in the clinical setting but did not report any patient results.…”

Operative Treatment of Acute Scaphoid Fractures

“…[34][35][36] More recent studies suggest that computernavigation techniques provide for greater accuracy in the percutaneous placement of screws. [37][38][39] Theoretically, the compressive effect of headless screw fixation offers a biomechanical means to achieve a more rapid time to union compared to cast immobilization alone. Return to work has been faster with surgical fixation compared to casting.…”