[Percutaneous osteosynthesis of scaphoid fracture with the Herbert-Whipple screw--technique and results]

In order to diminish the surgical trauma a percutaneous osteosynthesis of acute fractures of the scaphoid was performed in 22 cases using the cannulated Herbert-Whipple screw. Displaced fractures were reduced under fluoroscopy in a position of extension and supination while pulling the thumb with a weight of 5 kg by means of a Japanese finger trap. Additional correction could be achieved by using Kirschner wires as joysticks. The guide wire allowed a correct positioning of the cannulated screw. We have found that radiocarpal and midcarpal arthroscopy was of little benefit for fracture reduction. However, arthroscopy was important for the detection of concomitant carpal injuries. Due to minor projection over the distal scaphoid pole, three screws had to be removed underlining the difficulty of exact length determination. Sound bony union was achieved in all 22 cases even in those treated without plaster immobilisation. Limitations in wrist motion and grip strength have been found after concomitant injuries such as fractures of the distal radius and scapholunate ligament injury. On the other hand, there was no impairment of wrist function after percutaneous osteosynthesis of isolated scaphoid fractures. In conclusion, percutaneous osteosynthesis of the fractured scaphoid with the cannulated Herbert-Whipple screw permits a reliable treatment with minimal operative trauma.