Bullseye Intraoperative Imaging Technique Optimizes Scaphoid Fracture Fixation During Surgery

A recent publication highlights the newly developed “bullseye” and “perfect dot” intraoperative imaging technique that allows surgeons to confirm ideal scaphoid wrist fracture central screw fixation placement more accurately and efficiently than traditional imaging approaches. The article also highlights a minimally invasive technique for screw fixation of this common fracture without the need for an incision. The technique is described in the current issue of Techniques in Hand & Upper Extremity Surgery.

“This technique gives us a much more straightforward and accurate way to confirm that we have placed fixation exactly where it needs to be to optimize bone healing,” said Nicholas E. Rose, MD, hand and upper extremity surgeon at Hoag Orthopedic Institute and lead author of the study. “At the end of the day, precision matters and this technique can lead to stronger fixation, better healing, and help patients get back to their normal activities sooner.”

The small but essential scaphoid bone plays a critical role in wrist mobility and stability. It receives a limited blood supply, and fractures can be difficult to heal without meticulous treatment, making precise surgical fixation especially important.

The abstract, “’Bullseye’ Fluoroscopic View to Assess Center Scaphoid Screw Placement: Surgical Technique,” introduces an innovative way to use real-time imaging to guide hand surgeons during procedures to fix scaphoid fractures.

To repair the fractured scaphoid, a headless screw is inserted to stabilize the bone. The success of the procedure depends on placing that screw directly through the center pole of the scaphoid in order to maximize stability and promote proper healing. The surgeon also needs to ensure that the screw is placed completely within the scaphoid and does not penetrate its outer cortex -- the latter a scenario that could wear down wrist cartilage and lead to arthritis. The "bullseye" fluoroscopic intraoperative imaging technique is used to ensure accurate central screw placement during percutaneous scaphoid fracture fixation.

By adjusting the fluoroscopy C-arm to look directly down the cannulated screw axis, surgeons can confirm it is centered within the peanut-shaped scaphoid, optimizing fixation stability. The wrist is positioned so the surgeon looks down the axis of the guide pin and screw, providing a "perfect dot" or "bullseye" view on the monitor, ensuring the screw is not off-center or perforating the outer cortex of the bone.

This technique is useful for both open and percutaneous approaches to scaphoid fracture fixation, making it highly adaptable across different patient needs and clinical scenarios.