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Book Details
Abstract
Get a quick, expert overview of current diagnosis and management of scaphoid fractures with this concise, practical resource by Drs. Geert Buijze and Jesse B. Jupiter. This easy-to-read reference presents a summary of today’s best evidence-based approaches to diagnosis and management in this critical area.
- Provides must-know information on scaphoid fractures, including how to apply evidence-based management, anatomy, diagnosis, acute fracture management, malunion treatment, and nonunion management.
- Presents case scenarios followed by discussions of the importance of the problem, current opinion, evidence, and key recommendations.
- Consolidates today’s evidence-based information on scaphoid fractures into one convenient resource.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Scaphoid Fractures: Evidence-Based Management | i | ||
| Scaphoid Fractures: Evidence-Based Management | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| List of Contributors | vii | ||
| Foreword | xiii | ||
| Preface | xv | ||
| Contents | xix | ||
| I - INTRODUCTION | 1 | ||
| 1 - Using Evidence to Manage Scaphoid Fractures | 1 | ||
| INTRODUCTION | 1 | ||
| DIAGNOSIS OF TRUE FRACTURES AMONG SUSPECTED FRACTURES | 1 | ||
| DIAGNOSIS OF DISPLACEMENT AND FRACTURE INSTABILITY | 3 | ||
| CLASSIFICATION | 3 | ||
| TREATMENT | 4 | ||
| DIAGNOSIS OF UNION | 4 | ||
| DIAGNOSIS OF VASCULARITY AND TREATMENT OF NONUNION | 4 | ||
| NATURAL HISTORY AND SALVAGE PROCEDURES | 4 | ||
| CONCLUSION | 5 | ||
| REFERENCES | 5 | ||
| 2 - Principles of Evidence-Based Management of Scaphoid Fractures | 7 | ||
| THE ERA OF EVIDENCE-BASED MEDICINE | 7 | ||
| Principles of Evidence-Based Management | 9 | ||
| HIERARCHY OF EVIDENCE AND QUALITY | 10 | ||
| PRESENTATION OF RESEARCH FINDINGS | 12 | ||
| MAKING RECOMMENDATIONS | 15 | ||
| CONCLUSION | 17 | ||
| REFERENCES | 19 | ||
| II - ANATOMY | 21 | ||
| 3 - Anatomy of the Scaphoid Bone and Ligaments | 21 | ||
| IMPORTANCE OF THE PROBLEM | 21 | ||
| MAIN QUESTION | 21 | ||
| Current Opinion | 21 | ||
| Finding the Evidence | 21 | ||
| Quality of the Evidence | 22 | ||
| FINDINGS | 22 | ||
| Osseous Anatomy | 22 | ||
| Proximal pole and articulations | 23 | ||
| Distal pole and articulations | 23 | ||
| Scaphoid tubercle | 24 | ||
| Scaphoid waist | 24 | ||
| Vascular Anatomy | 24 | ||
| Ligament Anatomy | 25 | ||
| Volar ligaments | 25 | ||
| Radioscaphocapitate ligament. The radioscaph | 25 | ||
| Long radiolunate ligament. According to general consensus, the long radiolunate (LRL) originates ulnar to the RSC ligament on th... | 25 | ||
| Volar scaphotriquetral ligament. The existence of the volar scaphotriquetral ligament (vScTq) remains controversial. Its presenc... | 25 | ||
| Radioscapholunate ligament. The radioscapholunate (RSL) ligament originates on the volar rim of the distal radius and inserts on... | 26 | ||
| Scaphocapitate ligament. The scaphocapitate (ScC) is a large capsular ligament originating from the distal pole of the scaphoid.... | 26 | ||
| The scapho-trapezio-trapezoid ligament. The STT ligament comprises two or more bundles originating on the ulnar, volar, and radi... | 29 | ||
| Transverse carpal ligament. The transverse carpal ligament (TCL) is an extracapsular structure originating ulnarly on the hamate... | 31 | ||
| Radial collateral ligament. The radial collateral ligament (RCL) is a controversial structure. Some studies report it as a separ... | 31 | ||
| Dorsal ligaments | 31 | ||
| Dorsal intercarpal ligament. The dorsal intercarpal (DIC) ligament originates from the dorsoradial part of the triquetrum.1–3,48... | 31 | ||
| Dorsal radiocarpal ligament. The DRC ligament is most commonly described to originate from the distal radius and to insert onto ... | 32 | ||
| Scapholunate interosseous ligaments | 32 | ||
| Scapholunate interosseous ligament. The SLIO ligament is a C-shaped ligament spanning the perimeter of the scapholunate joint1 (... | 32 | ||
| RECOMMENDATIONS | 32 | ||
| CONCLUSION | 32 | ||
| REFERENCES | 32 | ||
| 4 - Vascular Supply to the Scaphoid | 35 | ||
| IMPORTANCE OF THE PROBLEM | 35 | ||
| MAIN QUESTION | 35 | ||
| Current Opinion | 35 | ||
| Finding the Evidence | 35 | ||
| Quality of the Evidence | 35 | ||
| FINDINGS | 36 | ||
| External Vascularity | 36 | ||
| Internal Vascularity | 38 | ||
| Clinical Correlations | 38 | ||
| RECOMMENDATIONS | 39 | ||
| CONCLUSIONS | 39 | ||
| REFERENCES | 39 | ||
| 5 - Dynamic Imaging and Kinematics of the Scaphoid | 41 | ||
| IMPORTANCE OF THE PROBLEM | 41 | ||
| MAIN QUESTION | 41 | ||
| Current Opinion | 42 | ||
| Finding the Evidence | 42 | ||
| Literature Search, Study Selection, and Data Extraction | 42 | ||
| Quality of the Evidence | 42 | ||
| FINDINGS | 43 | ||
| What Imaging Technique Is Used? | 43 | ||
| Is a Guided Motion Pattern Used to Replicate a Specific Motion? | 43 | ||
| What Is the Definition of the Neutral Position of the Wrist? | 43 | ||
| How Is Global Wrist Motion Defined? | 44 | ||
| Are the Positions of the Wrist in Which the Data Are Acquired Described? | 44 | ||
| Are the Measurements Performed on the 2D or 3D Images of the Carpal Bones? | 44 | ||
| What Coordinate System Is Used to Express Motion of the Carpals? | 44 | ||
| How Is the Fracture Location Determined? | 44 | ||
| Are the Kinematics of the Scaphoid Fragments Analyzed Separately? | 44 | ||
| Is the Analysis Technique Validated? | 45 | ||
| RECOMMENDATIONS | 45 | ||
| CONCLUSION | 46 | ||
| REFERENCES | 47 | ||
| III - DIAGNOSIS | 49 | ||
| 6 - Predictors of Scaphoid Fractures | 49 | ||
| IMPORTANCE OF THE PROBLEM | 49 | ||
| MAIN QUESTION | 52 | ||
| Current Opinion | 52 | ||
| Finding the Evidence | 52 | ||
| Quality of the Evidence | 52 | ||
| FINDINGS | 52 | ||
| Considerations for Future Research | 54 | ||
| RECOMMENDATIONS | 54 | ||
| CONCLUSION | 54 | ||
| REFERENCES | 58 | ||
| 7 - Diagnostic Work-up for Suspected Scaphoid Fractures | 61 | ||
| IMPORTANCE OF THE PROBLEM | 61 | ||
| Cost-effectiveness | 61 | ||
| MAIN QUESTIONS | 62 | ||
| Current Opinion | 62 | ||
| Finding the Evidence | 62 | ||
| Quality of Evidence | 62 | ||
| Diagnostic accuracy studies | 62 | ||
| Economic and decision analysis | 62 | ||
| Quality of evidence for diagnostic accuracy studies | 62 | ||
| Quality of evidence for cost-effectiveness studies | 62 | ||
| FINDINGS | 63 | ||
| Diagnostic Accuracy | 63 | ||
| Cost-effectiveness | 63 | ||
| RECOMMENDATIONS | 64 | ||
| CONCLUSIONS | 64 | ||
| REFERENCES | 65 | ||
| 8 - Classification Systems of Scaphoid Fractures | 67 | ||
| IMPORTANCE OF PROBLEM | 67 | ||
| MAIN QUESTION | 68 | ||
| Current Opinion | 68 | ||
| Finding Evidence | 68 | ||
| Quality of the Evidence | 69 | ||
| FINDINGS | 69 | ||
| Classifications Based on Fracture Location (Table 8.1) | 69 | ||
| Classifications Based on Fracture Plane Orientation (Table 8.2) | 69 | ||
| Classifications Based on Displacement and/or Instability (Table 8.3) | 69 | ||
| RECOMMENDATION | 72 | ||
| CONCLUSION | 72 | ||
| REFERENCES | 73 | ||
| 9 - Three-Dimensional Imaging of Scaphoid Fractures | 75 | ||
| IMPORTANCE OF THE PROBLEM | 75 | ||
| MAIN QUESTIONS | 75 | ||
| Current Opinion | 77 | ||
| Finding the Evidence | 77 | ||
| Quality of the evidence | 77 | ||
| FINDINGS | 77 | ||
| RECOMMENDATIONS | 78 | ||
| CONCLUSION | 79 | ||
| REFERENCES | 81 | ||
| 10 - Diagnosis of Displaced Scaphoid Fractures | 83 | ||
| IMPORTANCE OF THE PROBLEM | 83 | ||
| What Is the Definition of Displacement? | 83 | ||
| MAIN QUESTION | 84 | ||
| Current Opinion | 84 | ||
| Finding the Evidence | 84 | ||
| Quality of Evidence | 85 | ||
| FINDINGS | 85 | ||
| Evidence From Level III Studies | 85 | ||
| Evidence From Level IV Studies | 86 | ||
| Recommended Sequences for Radiography, CT, and MRI | 87 | ||
| RECOMMENDATION | 87 | ||
| CONCLUSIONS | 89 | ||
| REFERENCES | 89 | ||
| 11 - Scaphoid Fracture Instability | 91 | ||
| IMPORTANCE OF THE PROBLEM | 91 | ||
| MAIN QUESTION | 91 | ||
| Current Opinion | 91 | ||
| Finding the Evidence | 91 | ||
| Quality of the Evidence | 92 | ||
| FINDINGS | 92 | ||
| Recommendation | 95 | ||
| CONCLUSION | 95 | ||
| REFERENCES | 98 | ||
| IV - ACUTE FRACTURE MANAGEMENT | 99 | ||
| 12 - Surgical Versus Conservative Treatment for Nondisplaced Scaphoid Waist Fractures | 99 | ||
| IMPORTANCE OF THE PROBLEM | 99 | ||
| MAIN QUESTION | 99 | ||
| Current Opinion | 99 | ||
| Finding the Evidence | 100 | ||
| Quality of the Evidence | 101 | ||
| FINDINGS | 101 | ||
| Outcome Description | 101 | ||
| Results on Functional Outcome | 101 | ||
| Secondary Outcomes | 101 | ||
| In Favor of Conservative Treatment | 103 | ||
| In Favor of Surgical Treatment | 103 | ||
| Equivalence Between Surgical and Conservative Treatment | 103 | ||
| RECOMMENDATION | 104 | ||
| CONCLUSION | 104 | ||
| REFERENCES | 105 | ||
| 13 - Conservative Treatment of Nondisplaced and Minimally Displaced Scaphoid Waist Fractures | 107 | ||
| IMPORTANCE OF THE PROBLEM | 107 | ||
| MAIN QUESTION | 108 | ||
| Current Opinion | 108 | ||
| Finding of Evidence | 108 | ||
| Quality of Evidence | 109 | ||
| Below-elbow versus above-elbow cast | 109 | ||
| Thumb or no-thumb cast | 109 | ||
| Position of the wrist in the cast | 109 | ||
| Removable cast | 109 | ||
| Immobilization time | 109 | ||
| Pulsed electromagnetic field and pulsed low-intensity ultrasound therapy | 109 | ||
| FINDINGS | 109 | ||
| Below-Versus Above-Elbow Cast | 109 | ||
| Thumb or No-Thumb Immobilization | 109 | ||
| Position in the Cast | 110 | ||
| Removable Cast | 110 | ||
| Immobilization Time | 110 | ||
| Pulsed Electromagnetic Field and Pulsed Low-Intensity Ultrasound Therapy | 110 | ||
| RECOMMENDATIONS | 111 | ||
| CONCLUSION | 111 | ||
| REFERENCES | 112 | ||
| 14 - Acute Management of Proximal Pole Scaphoid Fractures | 115 | ||
| IMPORTANCE OF THE PROBLEM | 115 | ||
| MAIN QUESTION | 115 | ||
| Current Opinion | 116 | ||
| Finding the Evidence | 116 | ||
| Quality of the Evidence | 117 | ||
| FINDINGS | 117 | ||
| AUTHORS’ METAANALYSIS | 117 | ||
| RECOMMENDATION | 118 | ||
| CONCLUSION | 119 | ||
| 15 - Distal Scaphoid Fractures | 123 | ||
| IMPORTANCE OF THE PROBLEM AND CURRENT OPINION | 123 | ||
| MAIN QUESTION | 123 | ||
| Finding the Evidence | 123 | ||
| Quality of Evidence | 123 | ||
| ANATOMY | 123 | ||
| EPIDEMIOLOGY | 124 | ||
| FRACTURE BIOMECHANICS | 124 | ||
| CLASSIFICATION | 124 | ||
| IMAGING | 125 | ||
| TREATMENT | 126 | ||
| Nonunion | 126 | ||
| Posttraumatic Arthritis | 126 | ||
| OUTCOME | 126 | ||
| RECOMMENDATION | 126 | ||
| CONCLUSION | 126 | ||
| REFERENCES | 127 | ||
| 16 - Percutaneous Scaphoid Fixation: Volar and Dorsal Techniques | 129 | ||
| IMPORTANCE OF THE PROBLEM | 129 | ||
| MAIN QUESTION | 129 | ||
| Current Opinion | 129 | ||
| Finding the Evidence | 129 | ||
| Quality of the Evidence | 130 | ||
| FINDINGS | 130 | ||
| Historical Perspective | 130 | ||
| Indications | 130 | ||
| RECOMMENDATION | 139 | ||
| CONCLUSION | 139 | ||
| REFERENCES | 140 | ||
| FURTHER READING | 140 | ||
| 17 - Optimal Screw Placement | 143 | ||
| IMPORTANCE OF THE PROBLEM | 143 | ||
| MAIN QUESTION | 144 | ||
| Current Opinion | 144 | ||
| Finding the Evidence | 144 | ||
| Quality of the Evidence | 144 | ||
| Screw position | 144 | ||
| Approach | 145 | ||
| FINDINGS | 145 | ||
| Screw Position | 145 | ||
| Approach | 146 | ||
| RECOMMENDATION | 146 | ||
| CONCLUSION | 147 | ||
| REFERENCES | 149 | ||
| 18 - Arthroscopy-Assisted Screw Fixation | 151 | ||
| IMPORTANCE OF THE PROBLEM | 152 | ||
| MAIN QUESTIONS | 153 | ||
| Current Opinion | 153 | ||
| Finding the Evidence | 154 | ||
| Quality of the Evidence | 154 | ||
| FINDINGS | 154 | ||
| ANSWER TO THE MAIN QUESTIONS | 154 | ||
| RECOMMENDATION | 155 | ||
| CONCLUSION | 156 | ||
| REFERENCES | 162 | ||
| 19 - Displaced Scaphoid Fracture Treatment | 165 | ||
| IMPORTANCE OF THE PROBLEM | 165 | ||
| QUESTION 1 | 166 | ||
| Current Opinion | 166 | ||
| Search Strategy | 166 | ||
| Embase | 166 | ||
| Medline | 166 | ||
| Quality of the Evidence | 167 | ||
| Findings | 167 | ||
| QUESTION 2 | 168 | ||
| V - MALUNION TREATMENT | 215 | ||
| 24 - Diagnosing the Malunited Scaphoid | 215 | ||
| IMPORTANCE OF THE PROBLEM | 215 | ||
| MAIN QUESTION | 216 | ||
| Current Opinion | 216 | ||
| Finding the Evidence | 217 | ||
| Quality of the Evidence | 217 | ||
| FINDINGS | 217 | ||
| Choice of Imaging Modality | 217 | ||
| Measurable Parameters | 217 | ||
| Lateral Intrascaphoid Angle | 217 | ||
| Anteroposterior Intrascaphoid Angle | 218 | ||
| Height to Length Ratio | 218 | ||
| Dorsal Cortical Angle | 219 | ||
| Carpal Alignment | 219 | ||
| RECOMMENDATIONS | 219 | ||
| CONCLUSION | 220 | ||
| REFERENCES | 220 | ||
| 25 - Three-Dimensional Planning of Scaphoid Malunion and Nonunion Correction | 221 | ||
| IMPORTANCE OF THE PROBLEM | 221 | ||
| MAIN QUESTION | 223 | ||
| Current Opinion | 223 | ||
| Finding the Evidence | 223 | ||
| Quality of the Evidence | 224 | ||
| FINDINGS | 224 | ||
| RECOMMENDATION | 225 | ||
| CONCLUSION | 225 | ||
| REFERENCES | 228 | ||
| 26 - Corrective Osteotomy for Scaphoid Malunion | 229 | ||
| IMPORTANCE OF THE PROBLEM | 229 | ||
| MAIN QUESTION | 231 | ||
| Current Opinion | 231 | ||
| Finding the Evidence | 231 | ||
| Quality of the Evidence | 231 | ||
| FINDINGS | 231 | ||
| RECOMMENDATION | 232 | ||
| CONCLUSION | 234 | ||
| REFERENCES | 234 | ||
| VI - NONUNION MANAGEMENT | 237 | ||
| 27 - Diagnosing Vascularity Issues of the Scaphoid | 237 | ||
| IMPORTANCE OF THE PROBLEM | 237 | ||
| MAIN QUESTION | 237 | ||
| Current Opinion | 237 | ||
| Finding the Evidence | 237 | ||
| Quality of the Evidence | 238 | ||
| FINDINGS | 238 | ||
| Assessment of Scaphoid Vascularity and Viability | 238 | ||
| Preiser Disease | 241 | ||
| RECOMMENDATION | 242 | ||
| CONCLUSION | 242 | ||
| REFERENCES | 242 | ||
| 28 - Three-Dimensional Analysis of Nonunion Patterns | 245 | ||
| IMPORTANCE OF THE PROBLEM | 245 | ||
| MAIN QUESTION | 248 | ||
| Current Opinion | 248 | ||
| Finding the Evidence | 248 | ||
| Quality of the Evidence | 248 | ||
| FINDINGS | 248 | ||
| RECOMMENDATION | 248 | ||
| CONCLUSIONS | 248 | ||
| REFERENCES | 251 | ||
| 29 - Surgical Treatment for Fibrous-Delayed Scaphoid Nonunions | 253 | ||
| IMPORTANCE OF THE PROBLEM | 253 | ||
| MAIN QUESTION | 253 | ||
| Current Opinion | 253 | ||
| Finding the Evidence | 254 | ||
| Quality of the Evidence | 254 | ||
| FINDINGS | 254 | ||
| Conservative Treatment | 254 | ||
| Scaphoid Unions Without Substantial Bone Loss | 254 | ||
| Dorsal Percutaneous Approach | 255 | ||
| Mini-open Technique | 257 | ||
| Volar Percutaneous Approach | 257 | ||
| Postoperative Care | 265 | ||
| Scaphoid Nonunions | 265 | ||
| RECOMMENDATION | 267 | ||
| CONCLUSION | 267 | ||
| REFERENCES | 267 | ||
| 30 - Scaphoid Plating | 269 | ||
| IMPORTANCE OF THE PROBLEM | 269 | ||
| Overview | 269 | ||
| Plating Rationale | 269 | ||
| MAIN QUESTION | 270 | ||
| Current Opinion | 270 | ||
| Finding the Evidence | 270 | ||
| Quality of the Evidence | 271 | ||
| FINDINGS | 271 | ||
| Biomechanics | 271 | ||
| Indications | 272 | ||
| Contraindications | 272 | ||
| Clinical Data | 272 | ||
| RECOMMENDATIONS | 272 | ||
| CONCLUSION | 273 | ||
| REFERENCES | 274 | ||
| 31 - Vascularized Versus Nonvascularized Bone Grafts | 277 | ||
| IMPORTANCE OF THE PROBLEM | 277 | ||
| MAIN QUESTION | 277 | ||
| Current Opinion | 278 | ||
| Finding the Evidence | 279 | ||
| Quality of the Evidence | 279 | ||
| FINDINGS | 281 | ||
| RECOMMENDATION | 285 | ||
| CONCLUSION | 289 | ||
| REFERENCES | 289 | ||
| 32 - Vascularized Bone Grafts | 291 | ||
| IMPORTANCE OF THE PROBLEM | 291 | ||
| MAIN QUESTION | 293 | ||
| Current Opinion | 293 | ||
| Finding the Evidence | 293 | ||
| Quality of the Evidence | 293 | ||
| FINDINGS | 293 | ||
| Part 1: The Variety of Techniques | 293 | ||
| Part 2: Author’s Preferred Technique and Findings | 295 | ||
| RECOMMENDATION | 295 | ||
| CONCLUSION | 295 | ||
| REFERENCES | 301 | ||
| 33 - Nonvascularized Bone Grafts | 303 | ||
| IMPORTANCE OF THE PROBLEM | 303 | ||
| MAIN QUESTION | 303 | ||
| Current Opinion | 303 | ||
| Finding the Evidence | 304 | ||
| Quality of the Evidence | 304 | ||
| FINDINGS | 305 | ||
| Nonstructured Grafts | 305 | ||
| Structured Grafts | 305 | ||
| Three-Dimensional Reconstruction | 305 | ||
| Multiplanar Deformity | 306 | ||
| Patient-Specific Developments | 308 | ||
| Preferred Techniques | 308 | ||
| Long-Term Results | 308 | ||
| RECOMMENDATION | 308 | ||
| CONCLUSION | 308 | ||
| REFERENCES | 318 | ||
| 34 - Bone Morphogenetic Proteins for Scaphoid Nonunion | 321 | ||
| IMPORTANCE OF THE PROBLEM | 321 | ||
| MAIN QUESTION | 321 | ||
| Current Opinion | 321 | ||
| Finding the Evidence | 322 | ||
| Quality of the Evidence | 323 | ||
| FINDINGS | 323 | ||
| RECOMMENDATION | 324 | ||
| CONCLUSION | 324 | ||
| REFERENCES | 325 | ||
| 35 - Arthroscopic Bone Grafting for Scaphoid Nonunion | 327 | ||
| IMPORTANCE OF THE PROBLEM | 327 | ||
| Conventional Bone Grafting | 327 | ||
| Arthroscopic Bone Graft—A Novel Concept and Technique | 329 | ||
| MAIN QUESTION | 329 | ||
| Current Opinion | 329 | ||
| Finding the Evidence | 330 | ||
| Quality of the Evidence | 330 | ||
| FINDINGS | 330 | ||
| Authors’ Case Series | 330 | ||
| Surgical Technique | 332 | ||
| Arthroscopic Surveillance | 332 | ||
| Takedown of Nonunion | 332 | ||
| Correction of Humpback Deformity | 335 | ||
| Bone Grafting at Midcarpal Joint | 338 | ||
| Percutaneous Screw Fixation | 341 | ||
| Percutaneous Multiple K-Wire Fixation | 343 | ||
| Early Scaphoid Nonunion Advanced Collapse Wrist | 343 | ||
| Postoperative Care | 347 | ||
| Results | 348 | ||
| Discussion | 350 | ||
| RECOMMENDATION | 353 | ||
| CONCLUSION | 353 | ||
| REFERENCES | 353 | ||
| 36 - Salvage Procedures for SNAC Wrist | 355 | ||
| IMPORTANCE OF THE PROBLEM | 355 | ||
| THE QUESTION | 357 | ||
| Current Opinion | 357 | ||
| Finding the Evidence | 358 | ||
| Quality of the Evidence | 358 | ||
| FINDINGS | 358 | ||
| RECOMMENDATION | 364 | ||
| CONCLUSION | 364 | ||
| REFERENCES | 365 | ||
| Index | 367 | ||
| A | 367 | ||
| B | 367 | ||
| C | 368 | ||
| D | 368 | ||
| E | 369 | ||
| F | 369 | ||
| G | 369 | ||
| H | 369 | ||
| I | 370 | ||
| K | 370 | ||
| L | 370 | ||
| M | 370 | ||
| N | 370 | ||
| O | 371 | ||
| P | 371 | ||
| Q | 372 | ||
| R | 372 | ||
| S | 373 | ||
| T | 374 | ||
| U | 374 | ||
| V | 375 | ||
| W | 375 | ||
| X | 375 |