Acute rotary dislocation of the scaphoid: a new technique of repair using Herbert screw fixation across the scapho-lunate joint.

Abstract

Acute rotary dislocation of the scaphoid is commonly misdiagnosed and, if untreated, leads to progressive osteoarthritis of the wrist. The diagnosis requires a high degree of awareness and an understanding of the pathomechanics of the injury. To date, no single method of treatment has been shown to produce consistently satisfactory results. This paper presents a new surgical technique involving open reduction and reattachment of the ligament to the bone, combined with Herbert screw fixation across the scapho-lunate joint. The screw is normally left in situ for 12-18 months, allowing sufficient time for ligament healing and restoration of carpal stability. Using this technique early postoperative wrist motion is possible. Although excellent results have been achieved in the majority of cases, a few patients have developed increasing carpal collapse deformity in spite of adequate internal fixation, presumably due to inadequacy of the volar carpal ligaments. However, although the technique is a demanding one, the Herbert bone screw appears to offer significant advantages over standard Kirschner wire fixation in the treatment of acute rotary dislocation of the scaphoid.