- See:
- Casting of Scaphoid Fractures
- Surgery and Approach to the Scaphoid
- Herbert Screw Fixation of Scaphoid Fractures
- Closed Reduction of Scaphoid Fractures
- Radiographic Imaging
- Definition: Unstable Scaphoid Fracture
- Discussion:
- one must differentiate between stable & unstable acute frx, since stable fractures have a lower incidence of complications & may be treated w/immobilization in plaster;
- any movement or displacement which is seen at frx site indicates an unstable fracture, making internal fixation treatment of choice;
- Non Operative Treatment of Unstable Frx:
- rates of non-union after non-operative treatment of unstable frxs will approach 50 %;
- even when healing does occurr, there will also be a relatively high incidence of malposition & late collapse;
- Operative Treatment of Unstable Frx:
- primary internal fixation is treatment of choice for unstable scaphoid frxs;
- frx treated by primary internal fixation, avg time for return to work is 3.7 wks w/ union rate, 97 %;
- this compares very favorably with conservative treatment.
- implants include smooth K wires, cancellous bone screws;
- consider 2.0 mm or 2.7 mm cortex screws as lag screws;
- 3.5 mm cannulated screws as lag screws;
- Herbert screw
- screw is threaded at both ends and can be countersunk beneath articular surface, obviating the need for removal after frx has healed;
- it is designed to achieve compression by use of a differential thread-pitch between its proximal & distal ends, and it has guiding jig that maintains reduction & interfragmentary compression during insertion;
- disadvantages:
- interfragmentary compressive forces generated by Herbert screw are less than those associated with conventional screws;
- Post Op Care:
- even w/ Herbert screw fixation many recommend that immobilization be continued in short thumb-spica cast until there is evidence of frx union
Percutaneous pinning of symptomatic scaphoid nonunions.
Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid.
The Herbert screw for scaphoid fractures. A multicentre study.
Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation.