The head to foot screw fixation. A new technique of percutaneous screw fixation of the scaphoid bone.

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Published Sep 29, 2017
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Vol. 95 No. 1 (2017): Issue Jan 2017

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Mourad Zaraa
Safouane Ben Slama
Sabri Mahjoub
Heithem Sehli
Méhdi Hadj Salah
Mondher Mbarek

Abstract

Objectives: Many techniques have been described for screw fixation of the scaphoid bone. The approach is either proximal or dorsal. A new percutaneous technique is presented by the authors called the head to foot screw fixation. Indications and results are evaluated.

Methods: It is a percutaneous technique with fixation of the scaphoid bone by two screws introduced in an opposite direction: a proximal screw and a distal screw. No postoperative immobilization was necessary. A prospective study was conducted in 40 patients over a period of three years. The average age was 25 years with extremes of 14 and 44 years. This technique was practiced in fractures (30 cases) and nonunion (10 cases) in which the localization was proximal, corresponding to Schernberg types I, II and III. Forms associated with perilunate dislocation of the carpus were excluded from the study.

Results: The results were analysed with a mean of 8 months (6-30). Union was obtained in all the cases. No tendon injury related to percutaneous approach was noted. The technique required a learning curve with progressive decrease in operative time from 45 to 15 minutes. It was necessary in two cases to change protruding screws which were not diagnosed during the first intervention. Percutaneous screw fixation was achieved again in both cases.  

Conclusions: The combination in our experience of two screws allowed us to prevent rotation around the unthreated area of a single screw. Our technique, bringing together the head to the foot of the screw, reduces the crowding at the proximal part of the scaphoid bone. This non-invasive method permitted early mobilization with no pain until biological union.

Keywords:

Scaphoid bone, Fracture, Nonunion, Percutaneous fixation

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References

  1. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw, J Bone Joint Surg Br 1984;66:114-23.
  2. Alnot JY, Bellan N, Oberlin C, De Cheveigné C. Les fractures et pseudarthroses polaires proximales du scaphoïde carpien. Ostéosynthèse par vissage de proximal à distal . Annales de Chirurgie de la Main 1988;7:101-8.
  3. Whipple TL. Arthroscopic surgery. The wrist. Fractures of the scaphoid. Philadelphia, Lippincott, 1992, pp 148-56.
  4. Caloia MF, Martinez-Gallino RN, Caloia H, Rivarola H. Incidence of Ligamentous and Other Injuries Associated With Scaphoid Fractures During Arthroscopically Assisted Reduction and Percutaneous Fixation. Arthroscopy 2008;24:754-9.
  5. Bushnell BD, McWilliams AD, Messer TM. Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. J Hand Surg Am 2007;32:827-33.
  6. Schernberg F., Gerard Y. L'exploration radiologique dynamique du poignet. Rev Chir Orthop 1983;69:521-31.
  7. Ben Slama S, et al. Comment pratiquer un vissage percutané proximo-distal du scaphoïde carpien. Note de Technique. Tunisie Orthopédique 2010;3:69-72.
  8. Ledoux P, Chahidi N, Moermans JP, Kinnen L. Percutaneous Herbert screw osteosynthesis of the scaphoid bone. Acta Orthop Belg 1995;61:43-7.
  9. Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. J Bone Joint Surg Br 1998;80:95-9.
  10. Gaujoux G. Ostéosynthèse des fractures du scaphoïde par voie dorsale : une ou deux vis d'Herbert ? Chirurgie de la Main 2002;21:166-75.
  11. Martinache X, Mathoulin C. Ostéosynthèse percutanée des fractures du scaphoïde carpien avec assistance arthroscopique. Chirurgie de la main 2006;25:171-7.
  12. Alnot J Y. Fractures et pseudarthroses du scaphoïde carpien. Rev Chir Orthop. 1988;74:714-7.
  13. Van Den Bekerom MPJ, Hogervorst M, Bolhuis HW, Van Dijk CN. Operative aspects of the syndesmotic screw: Review of current concepts. Injury 2008;39:491-8.
  14. Brutus JP, Baeten Y, Chahidi N, et al. Ostéosynthèse percutanée des fractures du scaphoïde par la vis de Herbert : revue de 30 cas. Chirurgie de la main 2002;21:350-4.
  15. Newport ML, Williams CD, Bradley WD. Mechanical strength of scaphoid fixation. The Journal of Hand Surgery 1996;21:99-102.
  16. Adams BD, Blair WF, Reagan DS, Grundberg AB. Technical factors related to Herbert screw fixation. The Journal of Hand Surgery 1988;13:893-9.
  17. Ducharne G, et al. Rupture du tendon du fléchisseur radial du carpe après ostéosynthèse percutanée d'une fracture de scaphoïde. À propos d'un cas. Chirurgie de la main 2009;28:50-2.
  18. Thomsen S, Falstie-Jensen S. Rupture of the flexor pollicis longus tendon associated with an ununited fracture of the scaphoid. The Journal of Hand Surgery 1988;13:220-2.
  19. Failla JF, Koniuch MP, Moed BR. Extensor pollicis longus rupture at the tip of a prominent fixation screw: Report of three cases. The Journal of Hand Surgery 1993;18:648-1.