Management of the Intraarticular and Periarticular Fracture Using a Herbert bone screw: Clinical analysis of Technical Probleus of Surgery and Complications

Kim, In; Woo, Young Kyun; Chang, Ju Hae; Kim, Yong Sik; Song, Seok Whan; Kwon, Soon Yong; Yoo, Whan Kun

Abstract

32 cases of intraarticular and periarticular fractures treated with the Herbert bone screw were analyzed retrospectively by radiographic and functional assessment in the department of orthopaedic surgery of Catholic University Medical College from 1989 to 1994. 1. According to the anatomical distribution, there were various fracture sites as follows: 11 cases of carpal scaphoid, 7 cases of distal humerus, 4 cases of proximal radius, 3 cases of proximal humerus, 3 cases of femoral head,2 cases of distal radius, metacarpal head and medial malleolus in each 1 case. 2. Early and late radiographic assessment showed some complications as follows: 1) Through early radiographic assessment, there were 2 cases of inaccurate reduction of fracture fragment,2 cases of inappropriate fixation (out of bone) and 1 cases of insecure fixation followed by displacement of fracture fragment. 2) Through late radiographic assessment, there were 3 cases of posttraumatic arthritis, 2 cases of avascular necrosis of the osteochondral fracture fragment ; Of 3 cases of posttraumatic arthritis, 2 cases were related to the progressive protrusion of screw head resulting from degenerative thinning of the articular cartilage. Through this study, it was stressed that 1. Fracture personality must be evaluated for the appropriate use of Herbert screw, considering the fracture pattern and sites. 2. The head including a trailing thread must be inserted into the subchondral bone to prevent the protrusion of screw head, being aware of the progressive thinning of cartilage resulting from the inevitable posttraumatic arhritis or avasculsr necrosis of fracture fragment. 3. In the cases of osteochondral fracture deserving the shear force by musculotendinous pulling and joint motion, Herbert screw seems to be undesirable. 4. The Herbert screw is effective method, but needs skill and experience if errors are to be avoided.