Distribution Of Scaphoid Fracture Line And Its Relationship With Scaphoid Axis

Objective:The purpose of this study is to collect the distribution and direction of fracture lines,as well as their angulation with the axis.Based on classic fracture classification,the distribution of fracture lines is re counted,and the reliability of the axis is verified by analyzing each fracture line and axis angle,providing a basis for the formulation of clinical treatment plans and further research.Methods:The imaging data of patients with scaphoid fracture undergoing CT examination in our hospital were screened from the hospital database and exported using DICOM.DICOM format files are imported into Mimics 21.0 software,and tools such as Edit Masks are used to separate the scaphoid fracture fragments and perform threedimensional morphological reconstruction.Import the reconstructed fracture model into3-matic 13.0 software in STL file format.Translate the displaced fracture block and rotate it to reposition it.If the carpal scaphoid fracture is on the left,it can be mirrored to the right carpal scaphoid using the Mirror tool.Use the Scale tool to adjust the size of the restored three-dimensional fracture model to fit the standard template.Use the Smooth Carve tool to copy the fracture line of the fracture model on a standard template.According to the above,the fracture line of a patient can be obtained,and the threedimensional distribution of the carpal scaphoid fracture line can be obtained by copying and superposing the fracture lines of all cases on a standard template.Adding a long axis of the scaphoid bone to a standard carpal scaphoid model(the proximal pole of the scaphoid bone points towards the scaphoid node)can obtain all fracture lines and their angulation.Results:Statistical results of fracture line distribution and running direction: According to Mayo classification,79 patients(59.0% of the total)suffered from fracture of the middle1/3 of the scaphoid bone;21 patients with distal 1/3 fractures,accounting for 15.6% of the total;There were 34 patients with proximal 1/3 fractures,accounting for 25.3% of the total.According to Russell classification,there are 59 horizontal oblique fracture lines,accounting for 44.02% of the total;45 transverse fracture lines,accounting for 33.58% of the total;There are 30 vertical oblique fracture lines,accounting for 22.4% of the total.Statistical results of the Angle between fracture lines and axes :The average angle between the distal 1/3 fracture lines and the axis is 46 °,the average angle between the central 1/3 fracture lines and the axis is 62 °,and the average angle between the proximal1/3 fracture lines and the axis is 56 °.The average angle between each fracture line and the axis is 51 °,of which 42.5%(46/134)are greater than 60 °.Conclusion:The fracture prone locations in Mayo’s classification are basically consistent,and the determination of most travel directions in Russell’s classification is worth reconsidering.The classic classification of carpal scaphoid fractures has different emphasis,and clinical practice cannot completely rely on one of them.Personalized treatment should be combined with detailed CT data.The long axis pair of the scaphoid used in clinical practice is not suitable for all fracture lines,but the fixation effect for the middle 1/3 and proximal 1/3 is acceptable,while the distal 1/3 is slightly poor.Excessive pursuit of a vertical fracture line can sacrifice nail length and fixation stability.Appropriate compromise may be necessary,and a large number of sample studies are still needed to provide ideas.