Minimal Invasive Treatment for Scaphoid Fractures Using the Cannulated Herbert Screw System

摘要

Internal fixation of scaphoid fractures avoids the problems associated with prolonged plaster immobilization and, at the same time, allows an early return to activity for these mostly young patients. Internal fixation of the scaphoid is greatly facilitated by the use of specially designed headless bone screws, such as the Herbert bone screw, originally developed specifically for internal fixation of the scaphoid; furthermore, the advent of cannulated scaphoid screws has made closed (percutaneous fixation) stabilization of the scaphoid a reality. Indeed, this method has now become the treatment of choice for the majority of acute scaphoid fracture, bringing with it all the advantages of internal fixation without the disadvantages of open surgery. However, the success of closed treatment is also dependent on an accurate assessment of the fracture, and for this reason, we now advocate the routine use of computed tomography preoperatively. Because of the complex, 3-dimensional shape of the scaphoid, simple x-rays alone are inadequate, whereas computed tomography, parallel to the long axis of the scaphoid, allows excellent visualization of the fracture and any associated deformity, which must be corrected at the time of surgery. We describe here our method of treating acute scaphoid fractures, and we report the outcome of minimally invasive fixation.