Percutaneous Herbert screw osteosynthesis in trans-scaphoid perilunate fracture-dislocations.

UNLABELLED Trans-scaphoid perilunate fracture-dislocation is the most common variety of fracture-dislocations of the wrist. Because of the carpal scaphoid fracture association, post-reduction stability is poor, often requiring surgery. Of the several surgical techniques used over time, percutaneous screw fixation for scaphoid fracture is currently preferred. MATERIAL AND METHODS Six cases of trans-scaphoid perilunate fracture-dislocation were surgically treated by percutaneous reduction of the scaphoid fracture and percutaneous insertion of Herbert screw in a proximal to distal manner. Postoperative immobilization was followed by rapid resumption of wrist mobility. RESULTS Four of the six patients have resumed normal, painless mobility of the wrist within 3 to 6 weeks post immobilization; in the remaining two cases there were a slight wrist stiffness attributed to persistent slight rotatory deficiency between the fractured scaphoid fragments. CONCLUSIONS The percutaneous Herbert screw fixation provides a firm fixation with good compaction of scaphoid fracture, enough stability to allow minimal soft tissue and local damage, early mobilization following minimal immobilization, and thus rapid healing.