Scaphoid fracture: Percutaneous retrograde headless screw fixation using the Acumed Acutrak screw system
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Scaphoid fractures are commonly seen in the young adult male following a sporting injury or a fall on the outstretched hand. More than half of scaphoid fractures occur in the middle third of the bone, as the trabeculae here are the thinnest and most sparsely distributed. The fractures heal by intramembranous ossification with minimal callus to provide initial stability. Premature wrist loading results in varying degrees of shearing, bending and translational forces and will predictably angulate as volar bone is reabsorbed, yielding a “humpback” of flexion deformity of the scaphoid. An untreated or poorly treated scaphoid fracture is highly likely to progress to malunion or non-union. As the scaphoid is a pivotal bone joining the proximal and distal rows, this can result in significant alteration in the wrist biomechanics and degenerative arthritis. Therefore, timely management of the scaphoid fracture is crucial.
Scaphoid fractures are the second most common injuries in the wrist after distal radius fractures and treatments of the undisplaced and minimally displaced fractures of the scaphoid waist have been a source of debate for a long time. The advantages of conservative management in plaster versus surgical internal fixation have been extensively studied, with no clear consensus (Bond et al 2001, Buijze et al 2010, Dias et al SWIFFT Trial 2020) other than an agreement that a surgically fixed scaphoid fracture is likely to return to activity earlier.
The implants for surgical fixation of scaphoid have evolved significantly over the last 3 decades. Development of cannulated screws, which can be threaded over guide wires and inserted under fluoroscopic control, has minimized the soft tissue exposure and injury following an open fixation.
The Acumed Acutrak Headless Compression screw is a conical cannulated screw with the following features:
1. Minimal soft tissue irritation through Headless Fixation
2. Enhanced fracture fixation and improved pull-out strength through a Fully Threaded Construct using a Cancellous Based Thread Design
3. Enhanced window of compression through a Continuously Variable Screw Pitch
This is a Titanium implant with diameters ranging from 2.5mm-7.0mm; making it a versatile tool for a variety of surgical fixations. The Micro(2.5mm), Mini(3.5mm) and Standard(4.0mm) sizes are most suitable for a scaphoid fracture.
- Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. JBJS. 2001 Apr 1;83(4):483.
- Buijze GA, Doornberg JN, Ham JS, Ring D, Bhandari M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. JBJS. 2010 Jun 1;92(6):1534-44.
- Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, Brewster M, Brown D, Choudhary S, Coapes C, Cook L. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. The Lancet. 2020 Aug 8;396(10248):390-401.
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Author:Manish Gupta, Consultant Hand Surgeon.
Institution: The Queen Elisabeth Hospital, Birmingham, UK.