Herbert Screw Insertion in the Scaphotrapezial Joint

Abstract

The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.

Nonoperative Compared with Operative Treatment of Acute Scaphoid Fractures

“…As the attrition rate was very low in the present study, our results can actually be seen as a validation of those in the study by Saedén et al, which was limited by the fact that only 61% of the nonoperatively treated patients could be evaluated. The current results are not in agreement with those of Callanan et al 26 and Kehoe et al 27 , who used the less sensitive technique of plain radiography. They found no evidence of osteoarthritis in the scaphotrapezial joint five to seven years after insertion of a Herbert bone screw 26 or at a mean of eight years after injury 27 .…”

Occurrence of Carpal Osteoarthritis After Treatment of Scaphoid Nonunion With Bone Graft and Herbert Screw: A Long-Term Follow-Up Study

“…Progression was related mostly to failed anatomic reconstruction of the scaphoid or initial concomitant injury. In contrast to Callanan et al 36 and in agreement with Preisser et al, 31 Nicholl and Buckland-Wright, 37 and Kehoe et al 38 we found a high percentage of OA at the STT joint. In all of these patients the elevator was used to pry open the STT joint to gain access for the jig, which could explain the comparably high number of arthroses.…”

Degenerative Changes at the Scaphotrapezial Joint Following Herbert Screw Insertion: A Radiographic Study Comparing Patients with Scaphoid Fracture and Primary Hand Arthritis

“…If the head of the screw was left within the articular cartilage just below the surface it only ever became covered with a thin friable layer of fibrous tissue. Despite the above observations Callanan et al (1996) found no significant osteoarthritic change in the scaphotrapezial joint of 25 patients who had had a Herbert screw inserted 5 to 7 years previously. In addition, Filan and Herbert (1996) found no evidence of significant OA in the scaphotrapezial joint of 304 wrists in which a Herbert screw had been inserted.…”

“…The Herbert screw is widely used for the internal fixation of non-unions and is being increasingly used for the treatment of acute scaphoid fractures (Inoue and Shionoya, 1997;Werber and Hirgstetter, 1994). Barton (1996) has raised concerns that insertion of a Herbert screw might induce osteoarthritis (OA) in a previously normal joint, although other authors have not found evidence of OA at the scaphotrapezial joint in such patients (Callanan et al, 1996;Filan and Herbert, 1996). With this in mind we have undertaken an examination of three groups of patients using the improved spatial resolution of high definition macroradiography, to compare the incidence of degenerative changes in the scaphotrapezial joint of patients with primary OA of their hands, a scaphoid fracture successfully treated conservatively and patients treated with a Herbert screw.…”