A few years ago, I started putting in two Herbert screws for scaphoid fractures, with the thought that it would provide more rigid fixation. I think that it is helpful in some, but not all cases. Here are some of my results with a few variations... |
Click on each image for a larger picture |
1. Nondisplaced fracture in a surgeon who declined continuous immobilization. |
One week after screw stabilization using a limited dorsal approach, he was back operating, but splinted when not scrubbed. These films are one month post op: no visible fracture. |
Case 2. Nonunion with a large fracture cyst. After debridement, the defect, the graft, and yes, that is the capitate peeking through the defect. |
The graft, and inadequate seating of the more ulnar screw. |
Consolidation.. |
The poorly placed screw remained a source of pain, and the hardware was removed along with a styloidectomy. |
Case 3. Another postop, better screw positioning. |
Case 4. Nonunion with a graft and screws placed in both directions from a single palmar approach, hyperextending the wrist for the proximal entry... |
and with the graft: |
and with consolidation, |
Case 5. Another,same bidirectional
technique. Here, I ran the second screw too close to the first, and may
have flattened the leading threads - not
ideal. The preop status: |
With intercalated iliac bone graft... |
and healing. |
Case 6. A dorsal approach for this proximal pole fracture would have been a better choice. |
Case 7. This nonunion patient's scaphoid and iliac crest were unusually soft bone. |
Case 8. Transscaphoid perilunate fracture dislocation... |
Two screws put in dorsally, LT ligament reinforced with a strip of extensor retinaculum left attached to the triquetrium and anchored into the lunate; temporary capitolunate pin. |
Late, with asymptomatic partial union or nonunion, but no haloing. |
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Herbert screw scaphoid |
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