[Intermediate results in treatment of scaphoid pseudarthrosis and fracture with the Herbert screw]

The Herbert screw is a self-cutting headless screw that is designed to effect interfragmentary compression on being screwed in and is suitable for scaphoid surgery besides being useful also for other purposes. Although the Herbert screw is biomechanically inferior in many respects to the spongiosa screw, prognosis is impressively improved in scaphoid surgery (in pseudarthroses and fractures) by implanting the Herbert screw. It replaces the Matti-Russi plasty and is used in proximal, dislocated medium-positioned and unstable fractures. 73 scaphoid pseudarthroses and 27 fractures were treated with the Herbert screw between 1989 and 1991 at the Dept. of Orthopaedics at the University of Heidelberg. In 46% of problematic indications successful healing was achieved in more than 90% of the cases. However, surgical technique is complicated, requiring a certain amount of practice to keep iatrogenic traumatisations as low as possible. In the treatment of pseudarthroses special attention must be paid to careful and extensive sclerosis resection. Although the Herbert screw is screwed in through the articular surface, the procedure does not necessarily imply an accelerated development of arthrosis.