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Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation
S F Viegas1, J W Bean, R A Schram
1Division of Orthopaedic Surgery, University of Texas Medical Branch, Galveston 77550.
The Journal of Hand Surgery
|November 1, 1987
Summary
Open reduction and internal fixation with a Herbert screw effectively treated dorsal transscaphoid perilunate fracture/dislocations, yielding mostly excellent results. However, palmar transscaphoid lunate fracture/dislocations showed poor outcomes with this surgical approach.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Hand Surgery
Background:
- Transscaphoid perilunate fracture/dislocations are complex wrist injuries.
- Dorsal and palmar variants present distinct challenges in surgical management.
Purpose of the Study:
- To evaluate the outcomes of open reduction and internal fixation using Herbert screws for dorsal and palmar transscaphoid perilunate fracture/dislocations.
- To compare the efficacy of this surgical technique between the two fracture/dislocation patterns.
Main Methods:
- Retrospective review of eight male patients (average age 23.6 years) with transscaphoid perilunate fracture/dislocations.
- Six dorsal and two palmar injuries treated with open reduction and internal fixation of the scaphoid via Herbert screw.
- Two palmar injuries also received supplemental Kirschner wire stabilization.
- Follow-up averaged 18.9 months, with clinical evaluation using a scoring system for pain, function, range of motion, grip strength, and radiographic appearance.
Main Results:
- Dorsal transscaphoid perilunate fracture/dislocations: Three excellent, one good, and one fair outcome based on the clinical scoring system.
- Palmar transscaphoid lunate fracture/dislocations: Both cases demonstrated poor results.
- No specific complications were detailed, but outcomes differed significantly between injury patterns.
Conclusions:
- Open reduction and internal fixation with a Herbert screw is a viable treatment for dorsal transscaphoid perilunate fracture/dislocations, often leading to favorable outcomes.
- This surgical approach appears less effective for palmar transscaphoid lunate fracture/dislocations, suggesting a need for alternative or adjunctive treatments for these injuries.