This cadaveric micro-CT study maps the 3D intraosseous vascular architecture of 13 scaphoids. It quantifies how four screw trajectories disrupt that supply and defines two morphological subtypes with differing vascular robustness. The central question: does scaphoid shape predict blood supply vulnerability?
Gelberman and Menon's 1980 study established the retrograde nature of scaphoid blood supply, but was limited by the imaging technology of its era and did not describe volar waist vessels, inter-network anastomosis, or morphological subtypes that predict vascular robustness.
When fixing a scaphoid fracture, favor central axis or antegrade (dorsal) screw trajectories. Retrograde volar insertion disrupts nearly 10 percentage points more vascularity than the central technique (24.3% vs 14.5%) — a difference that may matter for healing and nonunion risk.
Before surgery, calculate the capitate fossa index (CFI) and waist index (WI) on a standard scaphoid view and lateral radiograph. A CFI > 0.6 and WI < 0.4 identifies a Type II (slender) scaphoid with intrinsically fewer vascular branches and no anastomotic reserve. Counsel these patients about heightened AVN and nonunion risk regardless of fracture displacement.
The authors note that vessel count and diameter may not directly reflect blood flow, and the small sample (n=13) warrants confirmatory studies before clinical thresholds are applied rigidly.
This cadaveric micro-CT study maps the 3D intraosseous vascular architecture of 13 scaphoids. It quantifies how four screw trajectories disrupt that supply and defines two morphological subtypes with differing vascular robustness. The central question: does scaphoid shape predict blood supply vulnerability?
Gelberman and Menon's 1980 study established the retrograde nature of scaphoid blood supply, but was limited by the imaging technology of its era and did not describe volar waist vessels, inter-network anastomosis, or morphological subtypes that predict vascular robustness.
When fixing a scaphoid fracture, favor central axis or antegrade (dorsal) screw trajectories. Retrograde volar insertion disrupts nearly 10 percentage points more vascularity than the central technique (24.3% vs 14.5%) — a difference that may matter for healing and nonunion risk.
Before surgery, calculate the capitate fossa index (CFI) and waist index (WI) on a standard scaphoid view and lateral radiograph. A CFI > 0.6 and WI < 0.4 identifies a Type II (slender) scaphoid with intrinsically fewer vascular branches and no anastomotic reserve. Counsel these patients about heightened AVN and nonunion risk regardless of fracture displacement.
The authors note that vessel count and diameter may not directly reflect blood flow, and the small sample (n=13) warrants confirmatory studies before clinical thresholds are applied rigidly.