Retrograde compression screw fixation of acute proximal pole scaphoid fractures

Rettig, Michael E.; Raskin, Keith B.

doi:10.1053/jhsu.1999.1206

Cited by 66 publications

(55 citation statements)

References 9 publications

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“…Ahigh union rate has been reported with immediate open repair of acute scaphoid fracturet reated with headless compression screw (7,8,9,10,11). However, significant complications have been reported using an open volar approach and rigid fixation with aHerbert screw (12,13).…”

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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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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“…Transplantation of bone graft is mandatory, if a multifracture zone exists. After image converter control to confirm the exact anatomic position of the scaphoid, either a cannulated conventional Herbert screw or a Mini Herbert screw will be applied [46].…”

Section: Dorsal Approachmentioning

confidence: 99%

Current Concepts in the Treatment of Scaphoid Fractures

Sauerbier

Germann

Dacho

2004

European Journal of Trauma

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Fractures of the carpus are frequent injuries and typically result from of a fall onto the outstretched hand. Scaphoid fractures are the second most frequent fracture type of the hand (80%). 95% of the patients with acute scaphoid fractures are male, and the average age is approximately 25 years. Conservative treatment of acute scaphoid fractures with immobilization in a plaster cast was the therapy of choice for a long time. Surgical treatment was reserved to severe dislocated fractures only. A progress could be obtained by the principle of intramedullary fixation, whose forerunner is represented by the Herbert screw, and the introduction of cannulated screws guaranteed a continuous improvement. The decision to treat the fracture by surgery requires a clear definition of the fracture type. Therefore, precise radiologic technique is mandatory to detect the fracture and to analyze the pathomorphological circumstances. In order to get an exact classification for the decision on how to proceed, three standard X-ray projections (posteroanterior [PA], lateral and Stecher projection) and a CT scan have to be performed. The most well-known classification has been defined by Herbert & Fisher which combines fracture anatomy, stability and disease history in order to derive prognostic and therapeutic criteria. Also, delayed healings and nonunions are considered. To decide on the adequate treatment, a prerequisite for conservative therapy of acute scaphoid fractures is the anatomic position of the scaphoid. Conservative therapy should be reserved to fracture types, which are stable and heal reliably in the lower-arm plaster cast within 6 weeks. All displaced and unstable acute scaphoid fractures should be operated, and whenever possible, rigid internal fixation should be achieved because of interfragmentary compression. Therefore, several intramedullary implants are available for surgical treatment of acute scaphoid fractures, e.g., Herbert screw, Mini Herbert screw, AO screw (cannulated), Acutrac screw (cannulated), or Twin-fix screw (cannulated). With improved surgical and radiologic techniques, most scaphoid fractures are amenable to minimally invasive fixation. The dorsal approach guarantees a good overview in treating proximal pole fractures. Yet, not all types of fractures can be treated in this way. Severely displaced fractures require the classic open palmar approach. In order to prevent the development of a scaphoid nonunion or an advanced carpal collapse (SNAC-wrist), an early and sufficient diagnostic algorithm is necessary. We recommend internal fixation with a cannulated Herbert screw in B1 and B2 fractures and a Mini Herbert screw in fractures of the proximal third (B3). A2 fractures can be treated conservatively. Early diagnosis and operative treatment will shorten the time off work, minimize the risk of nonunion, and reduce the costs of health care in the long term. IntroductionScaphoid fractures are the second most frequent fracture type of the hand. 95% of the patients with acute scaphoid fractures are mal...

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“…For fractures at the proximal third of the scaphoid, internal fixation is best carried out through a dorsal approach, using an intraosseous fixation device appropriate to the small size of the proximal fragment (14,26). The dorsal approach provides limited access with partial opening to the second and third extensor compartments and the wrist capsule over the scapholunate joint.…”

Section: Dorsal Approachmentioning

confidence: 99%

Wrist: Current Diagnosis and Treatment of Scaphoid Fractures and Injuries of the Scapholunate Ligament

Krimmer

2003

Eur Surg

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Summary: Background: Fractures of the scaphoid and injuries to the scapholunate ligament are mostly seen as causes of the acute and chronic painful wrist. Strict guidelines are necessary to precisely detect these lesions in the acute stage and to provide adequate treatment. A computed tomography bone scan parallel to the long axis of the scaphoid is best for demonstrating fractures and any associated deformities. Scapholunate ligament injuries are best staged by standard plane radiographs including stress views and by arthroscopy of the wrist. Methods: To avoid lengthy plaster immobilization and to lower the risk of nonunion, displaced and comminuted scaphoid fractures of the wrist as well as all proximal pole fractures should be internally fixed. Headless screws such as the Herbert screw, now available in a cannulated shape, allow the minimally invasive stabilization of the majority of these fractures with a high success rate under early mobilization. Undisplaced fractures can be treated conservatively with a below-elbow cast; alternatively, they can be stabilized percutaneously without the need for immobilization in a cast. Early diagnosis of scapholunate ligament injuries is most important, as anatomical healing of the injured ligaments can be expected only with primary treatment including correct realignment of the scaphoid and lunate followed by immobilization in a cast for about 8 weeks. In cases of chronic lesions, ligament reconstruction or even partial wrist fusion can be performed. In order to assess the different procedures, precise classification and staging with regard to a dynamic or static pattern are needed. Results: Early rigid fixation of scaphoid fractures promotes a union rate of up to 100 % with rapid functional recovery. Primary repair of scapholunate ligament injuries provides the best clinical outcome. Ligament reconstruction or partial wrist fusion can help to prevent rapid secondary arthrotic changes in the wrist and leads to significant pain relief, albeit with restriction of mobility and grip strength. Conclusions: Standardized diagnosis and treatment of scaphoid fractures and scapholunate ligament injuries improve clinical outcome and significantly reduce post-traumatic arthrotic changes in the wrist.

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Retrograde compression screw fixation of acute proximal pole scaphoid fractures

Cited by 66 publications

References 9 publications

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

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

Current Concepts in the Treatment of Scaphoid Fractures

Wrist: Current Diagnosis and Treatment of Scaphoid Fractures and Injuries of the Scapholunate Ligament

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