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Journal of the Korean Society for Surgery of the Hand 1998;3(2):216-227.
Published online January 1, 1998.
Herbert Screw Fixation in the Carpal Scaphoid Waist Fracture
Jun Mo Lee,Young Geun Lee
주상골 요부 골절에서 시행한 Herbert Screw 고정술
Scaphoid fractures are the most common fractures in the wrist joint and approximately 70% of the scaphoid fractures occur in the waist area. Displacement of a millimet er or more and apparent angulation between the fragments and increased obliquity with dorsal comminution indicates mechanical inst ability of the scaphoid fracture and requires the operative treatment . Delayed union and nonunion of the waist fracture also requires open reduction, rigid fixation and aut ogenous iliac cancellous bone grafting. Herbert screw provides ideal method of fixation for compression across the fracture with the thread on the leading end of the screw having a greater pitch than that at the trailing end. The amount of compression depends on the pit ch differential and the number of turns aft er the trailing thread ent ers the scaphoid. We had treat ed 13 carpal scaphoid waist fractures by Herbert screw fixation with or without aut ogenous iliac cancellous bone graft s from March 1989 through March 1998 at Department of Orthopedic Surgery, Chonbuk National Univer sity Hospital and followed up at average 16.7 months and the result s are followed. 1. The most common cause was fall on the ground (9 cases, 69%) and followed traffic accident (3 cases, 23%) and direct blow (1 case, 8%). 2. Iliac cancellous bone grafting was perfomed in the fresh relatively comminuted waist fracture, the dor sal transscaphoid perilunar dislocation, the delayed union and the established nonunion. 3. Bony union was obtained in average 13.8 weeks in 9 fresh fractures, 14weeks in the the dorsal transscaphoid perilunar dislocation, 16 weeks in 2 delayed union and 13 weeks in the nonunion. 4. Accurate reduction and rigid fixation could rest ore the scapholunate and capitolunate angle within normal limit in all 13 cases. 5. 3 cases (23%) were in the excellent result and 10 (77%) in good result according to the Maudsley method.

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