Acutrak versus Herbert Screw Fixation for Scaphoid Non-Union and Delayed Union
| Autor: | John O'beirne, John P Dillon, Benedykt Cichy, Kayode O Oduwole, Joan Wilson |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty medicine.medical_treatment Bone Screws Bone grafting Non union Fracture Fixation Internal Fractures Bone Fixation (surgical) lcsh:Orthopedic surgery Fracture fixation medicine Humans Scaphoid Bone business.industry equipment and supplies musculoskeletal system Herbert screw Surgery lcsh:RD701-811 surgical procedures operative Scaphoid bone Fractures Ununited Orthopedic surgery Delayed union Female business |
| Zdroj: | Journal of Orthopaedic Surgery, Vol 20 (2012) |
| ISSN: | 2309-4990 |
| DOI: | 10.1177/230949901202000112 |
| Popis: | Purpose.To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.Methods.Records of 132 patients who underwent Herbert screw fixation (n=61) or Acutrak screw fixation (n=71) with or without bone grafting for scaphoid non-union and delayed union by a single surgeon were reviewed. The most common fracture site was the waist of the scaphoid (n=95), followed by the proximal pole (n=31) and the distal pole (n=6). Screw placement was considered accurate (n=120) when the screw was placed in the central one-third (axially) of the scaphoid; otherwise it was eccentric (n=12). Bone union was assessed radiographically and clinically. Functional outcome was assessed using the modified Mayo wrist score.Results.Respectively in the Herbert and Acutrak screw groups, the mean patient ages were 25.3 and 27.3 years (p=0.28), the mean intervals between injury and screw fixation were 12.2 and 17 months (p=0.38), the mean durations to bone union were 2.1 and 1.8 months (p=0.63), and the union rates were 77% and 93% (p=0.01). The union rate was significantly higher in fractures of the waist of the scaphoid than in the proximal and distal poles (94% vs. 71% vs. 33%, p=0.001). The union rate was significantly higher when the screw was placed accurately (axially) than eccentrically (Herbert screw: 84% vs. 40%, p=0.006; Acutrak screw: 96% vs. 0%, p=0.004). 84% of the Herbert screws were placed axially, compared to 97% for the Acutrak screws. Respectively, 67% and 85% of patients had satisfactory functional outcomes (p=0.03), whereas 23% and 7% of the patients had persistent non-union (p=0.05).Conclusion.The Acutrak screw enabled more accurate screw placement and achieved higher union rates and modified Mayo wrist scores than the Herbert screw did. |
| Databáze: | OpenAIRE |
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