Gelberman and Menon mapped the blood supply outside and inside the scaphoid in cadavers to give an anatomic explanation for necrosis of the bone after fracture.
Anatomic study of 15 fresh cadaver specimens using arterial injection and bone clearing.
Methods
Specimens
15 fresh cadaver specimens
Method
Arterial injection
Bone clearing to show internal vessels
Measurements
Arterial origin of scaphoid branches
Dorsal vessel entry level relative to the waist
Share of intraosseous vascularity by source
Anastomoses with the anterior interosseous artery
Key Findings
Vessels entering through the dorsal ridge supplied 70% to 80% of the scaphoid, including the whole proximal pole.
Based on entry sites, a waist fracture would have significantly interrupted proximal pole supply in 14% of specimens and partially interrupted it in 59%.
Dorsal vessels entered at the level of the waist in 79% of specimens, proximal to it in 7% and just distal to it in 14%.
No connections between the dorsal and volar vessels were seen inside the bone.
The authors proposed that a volar approach would do the least damage to the vascular supply of the proximal pole.
Board pearl
The scaphoid proximal pole is fed only by vessels entering the dorsal ridge, with no intraosseous link to the volar system.
Authors' conclusion
An explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy is proposed. The volar operative approach would be least traumatic to the proximal pole's blood supply.
Gelberman and Menon mapped the blood supply outside and inside the scaphoid in cadavers to give an anatomic explanation for necrosis of the bone after fracture.
Anatomic study of 15 fresh cadaver specimens using arterial injection and bone clearing.
Methods
Specimens
15 fresh cadaver specimens
Method
Arterial injection
Bone clearing to show internal vessels
Measurements
Arterial origin of scaphoid branches
Dorsal vessel entry level relative to the waist
Share of intraosseous vascularity by source
Anastomoses with the anterior interosseous artery
Key Findings
Vessels entering through the dorsal ridge supplied 70% to 80% of the scaphoid, including the whole proximal pole.
Based on entry sites, a waist fracture would have significantly interrupted proximal pole supply in 14% of specimens and partially interrupted it in 59%.
Dorsal vessels entered at the level of the waist in 79% of specimens, proximal to it in 7% and just distal to it in 14%.
No connections between the dorsal and volar vessels were seen inside the bone.
The authors proposed that a volar approach would do the least damage to the vascular supply of the proximal pole.
Board pearl
The scaphoid proximal pole is fed only by vessels entering the dorsal ridge, with no intraosseous link to the volar system.
Authors' conclusion
An explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy is proposed. The volar operative approach would be least traumatic to the proximal pole's blood supply.