Technical factors related to Herbert screw fixation

Adams, Brian D.; Blair, W. Frank; Reagan, Douglas S.; Grundberg, Arnis B.

doi:10.1016/0363-5023(88)90267-5

Cited by 88 publications

(50 citation statements)

References 19 publications

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“…Screw stabilization is also thought to enable early physiotherapy and improve functional outcomes; however, the operative procedure is technically demanding and requires considerable individual experience. The procedure is further associated with quite high levels of intraoperative radiation exposure and screw misplacement rates of up to 5-30% [2][3][4][5]. Navigated procedures have recently been described as suitable tools for guiding percutaneous screw placement into the scaphoid.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

Catalá-Lehnen

Nüchtern

Briem

et al. 2011

Computer Aided Surgery

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Section: Introductionmentioning

confidence: 99%

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

Catalá-Lehnen

Nüchtern

Briem

et al. 2011

Computer Aided Surgery

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“…This technique also risks screw penetration of the joint (27). Mores ignificantly it has been observed that screws implanted along the central scaphoid axis resulted in faster healing (28,29,30). Using av olar approach, only an osteotomy and removal of the dorsal trapezium permit accurate placement of aguidewirev olarly with or without ag uidance jig.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Slade

Gillon

2008

Scand J Surg

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the purpose of this paper is to retrospectively review 234 consecutive cases of scaphoid fractures and nonunions treated using arthroscopy with the dorsal percutaneous implantation of ah eadless compression screw for healing and complications. solid union of fracture is determined by ct scan. we identified 126 acute injuries, including 65 proximal pole fractures; 67 grossly displaced fractures; 12 trans-scaphoid perilunate dislocations including four trans-scaphoid trans-capitate fractures; and ten combined scaphoid and distal radius fractures. 108 scaphoid nonunions were identified. 98 were correctly aligned and ten had ah umpback deformity which was correctable using arthroscopic assisted reduction techniques at the time of surgery.8 2p resented with af racture gap 2mm or greater requiring percutaneous bone grafting. 12 cases of avascular necrosis (avn) were identified by mRi. 20 nonunions had surgery performed at other institutions. the mean time to surgery for the nonunions was 20 months.99% union rate of acute scaphoid fractures was obtained by 12 weeks, as determined by ct scan. twoc omplications were identified (3%). one case of delayed healing was identified. this delayed union was treated with percutaneous bone grafting and continued on to heal uneventfully.the other complication was acase of volar trans-scaphoid peri-lunate dislocation. while the fracture healed, the patient developed at raumatic dislocation requiring ac apitate-lunate arthrodesis. tr eatment of scaphoid nonunions resulted in ten cases of delayed healing, which were treated with repeat percutaneous bone grafting. this represented a9 %c omplication rate. of the ten cases of delayed unions that were re-bone grafted, four failed to heal by nine months. this resulted in a 96% union rate of our nonunion group by nine months. when acute fracture healing was compared to nonunions the average healing of acute fractures as determined by ct scanning measuring trabecular bridging was 12 weeks, while the average healing of nonunions was 22 weeks. we conclude that the dorsal percutaneous treatment of scaphoid fractures and nonunions using arthroscopy is safe and effective. ct scans to evaluate scaphoid healing by measuring trabecular bridging at the fracture site was determined to be an excellent modality to evaluate scaphoid healing. while not witnessed in this series, the potential for complications requires proper training.

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“…Patients with avascular necrosis were not included in this difficult subset as vascularised bone grafts would be our first treatment in these patients [38]. Technical difficulties have been previously noted by many authors in the insertion of compression screws for scaphoid non-unions, especially when there is a cavitary or humpback deformity of the remaining un-united native scaphoid [1,16,36]. It is our experience that the insertion of a compression screw device is not necessary to achieve scaphoid union; furthermore, the routine use of such a device might lead to an increased number of bone grafts becoming either displaced (usually in a volar direction) or compressed, with resultant loss of scaphoid height/length and associated disruption to normal carpal mechanics.…”

Section: Discussionmentioning

confidence: 99%

Cancellous Bone Graft and Kirschner Wire Fixation as a Treatment for Cavitary-Type Scaphoid Nonunions Exhibiting DISI

Kirkham

Millar

2011

Hand (New York, N,Y.)

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Background Cavitary-type scaphoid non-unions represent one of the most difficult treatment challenges amongst all scaphoid non-unions as they exhibit bone loss, scaphoid shortening, flexion ('humpback') deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. Our technique and its rationale are presented in the largestto-date series on cavitary scaphoid non-unions exhibiting DISI. Methods Our technique for treatment of these cavitary nonunions is presented through a series of 27 patients. Results Union was achieved in (26/27) 96% of cases, with no complications. Carpal mechanics was restored, with an average carpal height index of 1.52±0.06, and an average scapholunate angle was 46±9°. Average follow-up was 2.2 years. Conclusion In this subset of patients, we believe this technique is less technically demanding than the use of either cortico-cancellous grafts or various compression screws. Our success equals or betters that of other published techniques, with all patients enjoying a full return to work, even in occupations demanding heavy labour. We believe that scaphoid union, coupled with the often difficult restoration of carpal height and intra-carpal angles, has produced very good functional outcomes in the management of these challenging cases.

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Technical factors related to Herbert screw fixation

Cited by 88 publications

References 19 publications

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Cancellous Bone Graft and Kirschner Wire Fixation as a Treatment for Cavitary-Type Scaphoid Nonunions Exhibiting DISI

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