Which is the Best Solution for Achieving Maximal Interfragmentary Compression of the Scaphoid Fractures - One or Two Herbert Screws?

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Abstract

[Indexed for MEDLINE] 9. J Wrist Surg. 2019 Dec;8(6):446-451. doi: 10.1055/s-0039-1692470. Epub 2019 Jul 12. Scaphoid Fracture Patterns-Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification. Drijkoningen T(1), Mohamadi A(1), van Leeuwen WF(1), Schwarcz Y(2), Ring D(3), Buijze GA(4). Author information: (1)Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. (2)Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. (3)Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas. (4)Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital, Montpellier, France. Objective  To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods  The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results  Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification ( P