New Orleans, LA—March 8, 2018
A study presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2018 Annual Meeting suggests that poor blood supply may not be the reason why certain bone fractures of the wrist do not heal properly, as previously thought. The findings also may help surgeons better plan surgical approaches to fracture repair while also identifying patients who will likely have a tougher go at recovery and require more follow up care.
The movement of our hands and wrists partially relies on a small, cashew-shaped bone called the scaphoid. The proximal pole of the bone — meaning the end abutting the arm rather than the hand — is notoriously slow to heal following a fracture and is prone to a condition called avascular necrosis, in which the bone tissue dies due to lack of blood supply.
It was previously thought that the poor healing was due to a unique and lacking vasculature at the bone’s proximal end. Yet the new study found that this area of the bone actually receives over 37 percent of the scaphoid’s entire blood supply, so it is actually as well-nourished as the other two regions of the bone. However, the very tip of the proximal pole did appear to have minimal vasculature perhaps explaining why it is prone to healing problems following a break.
"Our study suggests that the proximal pole of the scaphoid actually has a similar amount of internal blood supply as the rest of the scaphoid, not less as has traditionally been taught," says Duretti Fufa, MD, hand and upper extremity surgeon at Hospital for Special Surgery (HSS) in New York City and lead author of the new study. "If the amount of blood supply in the proximal pole of the scaphoid is not different from the rest of the scaphoid, then we need to think of alternative explanations for the poorer results of treatment in this area."
Dr. Fufa explains that the poor healing rates seen in proximal scaphoid break could be due to mechanical influences or injury pattern more so than simply blood supply.
The vasculature of the scaphoid was originally described decades ago and based on cadaver dissections. Dr. Fufa and her HSS colleagues who took part in the study also utilized cadaver analysis to achieve their results. However modern, high-resolution imaging technologies allowed them to better characterize the vessels that supply blood to the scaphoid.
To follow up the new study, Dr. Fufa and fellow HSS hand specialists are collaborating to review the break and healing patterns of hundreds of patients with broken scaphoid bones.
"Our goal is to see if we can determine alternate classification systems for describing scaphoid fractures that incorporates this new information and may better inform our treatment of these injuries," she says.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.