HERBERT SCREW FIXATION OF SCAPHOID FRACTURES

Hand Surgery ◽  
1999 ◽  
Vol 04 (01) ◽  
pp. 63-66 ◽  
Author(s):  
C. K. Low ◽  
B. T. Ang
Keyword(s):  
Screw Fixation ◽  
Type B ◽  
Scapholunate Dissociation ◽  
Herbert Screw ◽  
Scaphoid Fractures ◽  
Type D ◽  
Type C ◽  
Unstable Type ◽  
Radiological Union

Forty-four scaphoid fractures treated with open reduction and internal fixation using the Herbert screw were available for evaluation at an average follow-up period of 2.1 years and a range of 1 to 6 years. They were classified according to Herbert into 25 unstable (type B); 8 delayed unions (type C); and 11 nonunions (type D). Bone grafting was required in 22 cases. Sound radiological union was achieved in 42 cases at an average of 3.2 months. The two nonunions healed after revision grafting. Using the Mayo wrist score, excellent results were achieved in 14 cases; good in 22; fair in 4; and poor in 4. Poor results were associated with nonunion in two; untreated scapholunate dissociation in 1; and screw protrusion in 1.

Scaphoid Fractures Treated by Herbert Screw Fixation

1988 ◽  
Vol 13 (4) ◽  
pp. 453-455
Author(s):  
R. MORAN ◽  
J. CURTIN
Keyword(s):  
Screw Fixation ◽  
Senior Author ◽  
Screw Loosening ◽  
Type B ◽  
Herbert Screw ◽  
Cast Immobilisation ◽  
Scaphoid Fractures ◽  
Type D ◽  
Type C ◽  
Time From Injury

Forty-one scaphoid fractures had Herbert screw fixation. There were three acutely displace fractures (Type B), nine delayed unions (Type C), and 29 non-unions (Type D). All procedures were carried out by the senior author between December 1983 and May 1987. The average time from injury to surgery was 19 months. All Type D fractures were bone-grafted. Six of the 29 Type D fractures failed to unite radiologically following surgery. Incorrect screw placement was a factor in two cases. The average time from injury to surgery in three of the others was seven years. Radiological evidence of screw loosening was present within two months of mobilising these cases. We feel that Herbert screw fixation may not be adequate when dealing with longstanding scaphoid non-unions, and stronger fixation or prolonged cast immobilisation may be necessary.

Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study

2019 ◽  
Vol 130 (5) ◽  
pp. 1468-1477 ◽  
Author(s):  
David Hasan ◽  
Mario Zanaty ◽  
Robert M. Starke ◽  
Elias Atallah ◽  
Nohra Chalouhi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Type B ◽  
Type D ◽  
Type C ◽  
Radiographic Classification

OBJECTIVEThe overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA and to assess the changes in systemic blood pressure following successful revascularization.METHODSThe radiographic images of 100 consecutive subjects with COICA were analyzed. A new classification of COICA was proposed based on the morphology, location of occlusion, and presence or absence of reconstitution of the distal ICA. The classification was used to predict successful revascularization in 32 symptomatic COICAs in 31 patients, five of whom were female (5/31 [16.13%]). Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy. Carotid artery occlusion was defined as 100% cross-sectional occlusion of the vessel lumen as documented on CTA or MRA and confirmed by digital subtraction angiography.RESULTSFour types (A–D) of radiographic COICA were identified. Types A and B were more amenable to safe revascularization than types C and D. Recanalization was successful at a rate of 68.75% (22/32 COICAs; type A: 8/8; type B: 8/8; type C: 4/8; type D: 2/8). The perioperative complication rate was 18.75% (6/32; type A: 0/8 [0%]; type B: 1/8 [12.50%]; type C: 3/8 [37.50%], type D: 2/8 [25.00%]). None of these complications led to permanent morbidity or death. Twenty (64.52%) of 31 subjects had improvement in their symptoms at the 2–6 months’ follow-up. A statistically significant decrease in systolic blood pressure (SBP) was noted in 17/21 (80.95%) patients who had successful revascularization, which persisted on follow-up (p = 0.0001). The remaining 10 subjects in whom revascularization failed had no significant changes in SBP (p = 0.73).CONCLUSIONSThe pilot study suggested that our proposed classification of COICA may be useful as an adjunctive guide to determine the technical feasibility and safety of revascularization for symptomatic COICA using endovascular techniques. Additionally, successful revascularization may lead to a significant decrease in SBP postprocedure. A Phase 2b trial in larger cohorts to assess the efficacy of endovascular revascularization using our COICA classification is warranted.

scholarly journals Scaphoid Fracture: Functional Outcome Following Fixation with Herbert Screw

2012 ◽  
Vol 9 (4) ◽  
pp. 267-273 ◽  
Author(s):  
N P Parajuli ◽  
D Shrestha ◽  
D Dhoju ◽  
R Shrestha ◽  
V Sharma
Keyword(s):  
Functional Outcome ◽  
Open Reduction ◽  
Screw Fixation ◽  
Scaphoid Fracture ◽  
Operative Management ◽  
University Hospital ◽  
Volar Approach ◽  
Herbert Screw ◽  
Scaphoid Fractures ◽  
Radiological Union

Background Most scaphoid fractures though heal uneventfully with cast treatment, immobilization with cast is associated with complication like wrist stiffness. Open reduction and fixation with Herbert Screw though technically demanding procedure can yield excellent results and prevents complication like nonunions and loss of wrist function. Objectives To assess clinical outcome and radiological union of scaphoid fracture after operative management following Herbert screw fixation in patient attending Dhulikhel Hospital. Methods All scaphoid fracture, treated from Feb 2007 till Feb 2011, were retrospectively studied in Dhulikhel Hospital, Kathmandu University Hospital. Fifteen patients with scaphoid fractures were treated with Herbert screw. Fourteen were males and one was female. Serial radiographs were taken to assess radiographic union and functional outcome was assessed using Modified Mayo wrist score. Results Out of 15 patients, 13 scaphoid had waist fractures and two had proximal pole factures. All scaphoid were treated with open reduction and Herbert screw fixation either by volar approach or by dorsal approach. All fractures maintained good alignment post operatively. Nine (60%) patients had excellent results with normal wrist range of motion, five (33.3%) patients had good results and one (6.7%) patient had poor outcome. In 14 (93.3%) patients good radiological union was seen at final follow up at six months time. Conclusion Fixation with Herbert screw for scaphoid fracture is an effective and convenient way of treatment with satisfactory functional outcome and less complication.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6342 Kathmandu Univ Med J 2011;9(4):267-73

scholarly journals Usefullness of 2D/3D-TEE for guiding transapical beating heart neochordae implantation in mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Mahia ◽  
J Cobiella ◽  
M Carnero ◽  
D Enriquez ◽  
J.A De Agustin ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Type A ◽  
Beating Heart ◽  
Correct Selection ◽  
Diagnostic Tools ◽  
Type B ◽  
Type D ◽  
Type C ◽  
Leaflet Prolapse

Abstract Background Transapical beating-heart neochord implantation (Neochord) to repair mitral valve regurgitation has been demonstrated to be a safe and effective minimally invasive alternative to open surgical repair in selected patients with mitral leaflet prolapse. Successful neochordae implantation depends on accurate localization of the site of regurgitation and careful assessment of MV morphology. The objective of this study is to demonstrate that 3D-transesophageal echocardiography (3D-TEE) has become a fundamental tool, essential in both the preoperative study and to guide the procedure and for follow-up. Methods All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between March 2017-Jan 2021 were included. Patients were categorized according to MV anatomy by 3D-TEE; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Results 43 patients were included. Median age was 67.7±13.4 y. Median EuroSCOREII 2.7%±1.91. There were 35 Type A patients (81.4%), 4 Type B (9.3%), 1 Type C (2.3%), and 3 Type D (7%). Type A was considered the more favorable morphology. 2D/3D TEE were employed for guiding the device from the apex of the left ventricle across the mitral annulus (Figure 1, A–C), orientation of the tip of the device with regards to the prolapsing segment of the leaflet positioning and leaflet grasping (Figure 1, D, E) and evaluation of the final length and tension of the neochordae to obtain a satisfactory mitral valve competence. (Figure 1, F). Procedural success was achieved in 38 patients (88,4%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. 1 high-risk patient considered inoperable died before discharge. At 19 (IQR 13–23) months median follow-up, MR ≤II was present in 29 (76.3%). Overall 2 year survival was 100%. Freedom from reintervention was 89% for overall population. Conclusions TEE-Guided Transapical beating-heart neochord implantation is a feasible, low-risk technique. 2D and 3D TEE are the fundamental and essential diagnostic tools for the correct selection and monitoring of the procedure, as well as its possible complications. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

Percutaneous Cannulated Screw Fixation of Acute Scaphoid Waist Fracture

2002 ◽  
Vol 27 (1) ◽  
pp. 42-46 ◽  
Author(s):  
H. S. F. YIP ◽  
W. C. WU ◽  
R. Y. P. CHANG ◽  
T. Y. C. SO
Keyword(s):  
Prospective Study ◽  
Functional Recovery ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Union Rate ◽  
Scaphoid Fractures ◽  
Mean Time ◽  
Radiological Union

This prospective study assessed the outcome of percutaneous cannulated screw fixation in 49 of 60 acute scaphoid fractures. The union rate was 100% (mean time for radiological union at 12 weeks). There were no early or mid-term complications and all achieved an excellent functional recovery.

scholarly journals The effectiveness of TiO2 additions to mortar to maintain initial conditions in terms of its reflectance to solar radiation

2017 ◽  
Vol 17 (3) ◽  
pp. 39-56 ◽  
Author(s):  
Sérgio Roberto Andrade Dantas ◽  
Fulvio Vittorino ◽  
Kai Loh
Keyword(s):  
Solar Radiation ◽  
Ultraviolet Radiation ◽  
Initial Conditions ◽  
Type A ◽  
Just Noticeable Difference ◽  
Type B ◽  
Climate Conditions ◽  
Type D ◽  
Type C ◽  
Over Time

Abstract Contact of facades with degradation agents and direct incidence of ultraviolet radiation on external coatings make them more opaque over time, affecting their colour and reflectance characteristics. This study evaluated the effect of adding different TiO2 contents to mortars applied in concrete substrates in order to verify the reflectance maintenance on surfaces after exposure over time. Mortar with different concentrations of TiO2 (1%, 5%, 10%) were produced in relation to the total dry premix, added as a powder and compared to unpainted mortar without TiO2 (type "A") and painted mortar without TiO2 (type "B"), both used as a reference for colour and reflectance. Exposed over 16 months to climate conditions in São Paulo, regarding the maintenance of reflectance and solar radiation, the results showed that type "B" (0%TiO2) painted mortar presented the best performance. Type "C" (1%TiO2) and type "D" (5%TiO2) unpainted mortar remained more stable. Type "A" (0%TiO2) and type "E" (10%TiO2) unpainted mortar showed greater differences according to the Just Noticeable Difference (JND) range caused by dirt pick up.

Herbert Screw Insertion in the Scaphotrapezial Joint

1996 ◽  
Vol 21 (6) ◽  
pp. 775-777 ◽  
Author(s):  
I. CALLANAN ◽  
O. LAHOTI ◽  
J. P. McELWAIN
Keyword(s):  
Screw Insertion ◽  
Herbert Screw ◽  
Scaphoid Fractures ◽  
Long Term Follow Up

The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.

scholarly journals Therapeutic Analysis of Herbert Screw Fixation for Capitellar Fractures via the Anterior Approach in Children

2021 ◽  
Author(s):  
Lingpeng Ju ◽  
Linjun Jiang ◽  
Yuan Zhang ◽  
Jun Wu ◽  
Ming Li ◽  
...  
Keyword(s):  
Performance Index ◽  
Open Reduction ◽  
Anterior Approach ◽  
Screw Fixation ◽  
Rating System ◽  
Bony Union ◽  
Imaging Data ◽  
Herbert Screw ◽  
Elbow Function

Abstract Objective: To analyse the efficacy of open reduction and Herbert screw fixation for coronal fractures of the capitellum via the anterior approach in children.Methods: We retrospectively analysed the clinical and imaging data of 15 children with capitellar fractures who were admitted to our hospital from May 2014 to May 2019. The fracture was reduced through the cubital crease incision via the anterior approach and was internally fixated with Herbert screws. A follow-up was conducted after the operation to examine the fracture healing and elbow function. The postoperative functional recovery of patients was evaluated with the Mayo Elbow Performance index (MEPI) and the Broberg-Morrey rating system.Results: Patients underwent surgery 3.7 days after injury on average. Intraoperative fracture reduction was satisfactory. No vascular injury or nerve injury occurred. Bony union occurred in an average of 6 weeks after the operation. All children completed 12- to 36-month follow-up. At the last follow-up, the Mayo Elbow Performance index was considered excellent in 12 patients and good in three patients. The Broberg-Morrey score was considered excellent in 12 patients, good in two patients, and fair in one patient. Conclusion: Open reduction and Herbert screw fixation via the anterior approach are an ideal surgical method for the treatment of coronal fractures of the capitellum in children.Levels of Evidence: Therapeutic, retrospective study-Level IV

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