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

Abstract

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.

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.…”

Establishing a central zone in scaphoid surgery: a computational approach

“…Some authors suggest that the trapezium resection could not be avoided when attempting to insert the screw centrally. Opponents claim this would increase the chance of degenerative change in the scaphotrapezial joint [6,14]. Our study suggests such results are partly due to different determinations of "central" placement of a screw.…”

Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study

“…In an effort to provide perpendicular direction of the guide wire to the fracture line, some surgeons insert the wire through trapezium or perform a partial resection of the trapezium 23 . This method involves risk of later carpometacarpal or scaphotrapezial arthrosis development 24,25 . The above facts justify our choice of the palmar percutaneous and dorsal limited approaches for the surgical treatment of nondislocated or minimally dislocated scaphoid waist fractures.…”