Eur J Plast Surg (1998) 21:207±208
F.W. Peter ´ A. Yousef ´ P.M. Vogt ´ A. Torres
Ipsilateral scaphoid and intra-articular radius fracture treated
by Herbert screw fixation
Received: 6 May 1997 / Accepted: 12 August 1997
F.W. Peter (
) ´ A. Yousef ´ P.M. Vogt ´ A. Torres ´ H.U. Steinau
Department of Plastic Surgery, Burn Center,
Bergmannsheil University, Hospital, P.O. Box 100 250,
D-44702 Bochum, Germany
Tel. +49-234-302 6841;
Fax +49-234-302 6379; e-mail: 75473.672 @CompuServe.Com
Abstract The type and extent of a wrist lesion depends on
the angulation of the hand, the force of impact and the age
of the patient. We report on an unusual transscaphoidal
subluxation fracture in combination with a shear fracture
of the radius, caused by a low impact hyperextension trau-
ma. To provide interfragmentary compression and a free
mobility of the articular surfaces, two Herbert screws were
used for osteosynthesis. The Herbert screw was designed
originally for osteosynthesis of scaphoid fractures. As this
implant can be buried completely within the bone, it al-
lows fixation of other small articular fragments according-
ly. This is demonstrated in the patient presented here who
had a hyperextension trauma with unusual consequences.
Key words Hyperextension trauma ´ Combined wrist
fracture ´ Herbert screw
A 37-year-old patient was admitted to the emergency room after
falling on his hyperextended left hand. The wrist was swollen and
tender, the range of motion was reduced to minimal excursions.
Neurologically the patient presented with paresthesia of the median
X-ray examination of the left wrist showed (Fig. 1):
· a fracture of the scaphoid
· two fragments which could not be related immediately to a bony
· a lunate which was subluxated palmarly
· an old fracture of the ulnar styloid.
Additional tomograms and CT scans provided further information
on the injury:
· the fragment (Fig. 2, above) which was displaced into the palmar
region was identified as the proximal part of the fractured scaph-
oid (see Fig. 1)
· the fragment (Fig. 2, below) dislocated palmarly was the volar lip
of the articular radius surface (see Fig. 1). The images confirmed
that the lunate was subluxated palmarly.
Via a palmar approach the carpal tunnel was released and the intact
median nerve identified. The scaphoid fracture could be reduced by
fixating the proximal fragment with a Herbert screw in a standard
fashion. The disclosed osteochondral volar fragment of the radius
was also fixated with a Herbert screw. Finally the ruptured radio-
carpal and carpal ligaments were reconstructed with 4-0 nylon su-
tures. The result after osteosynthesis is shown in Fig. 3.
A forearm cast including the thumb was applied for four weeks.
Then the patient performed intensive physical therapy for additional
four weeks. A follow-up examination 12 months after the accident
revealed full strength and painless motion for the wrist and forearm
(Tab. 1, Fig. 4).
The specific mechanism of hyperextension of the wrist is
usually not associated with a volar fragment of the radial
articular surface. Since a stable ligamentous fixation of
the lunate to the carpus and the two fragments to the distal
radius was found intraoperatively, a transscaphoidal sub-
luxation fracture combined with a shear fracture of the ra-
dius is most likely the definition of this injury [1, 2]. It
cannot be determined whether the preexistent wrist frac-
ture predisposed the patient to this type of injury, which
usually occurs only after high impact injuries .
The type of injury seen here differs from the lesions
typically seen after hyperextension trauma of the wrist.
· fracture of the scaphoid
· perilunate dislocation
· transscaphoid perilunate fracture dislocation (de Quer-
· rare forms and combinations
In all cases, reduction is mandatory. If instability or dislo-
cation prevails, surgery to reestablish bony stability and/
or ligamentous continuity has to be performed.
Table 1 Range of motion of both wrists 12 months after surgery
Ext.-0-flex.: 70-0-45 80-0-45
Radial-0-ulnar dev: 20-0-20 20-0-30