Headless Screws Research Articles

English

BACKGROUND High velocity motor vehicle injuries are associated with hip fracture dislocations especially dash board injuries. Most commonly posterior hip dislocations are associated with occasional femoral head fractures. Computerized tomographic imaging is done to look at the congruency of the hip joint. Safe surgical dislocation or Ganz approach was described in 2001 for exposing the hip in a 360-degree view without damaging the vascularity of the femoral head. In this study, we wanted to evaluate the radiological and functional outcome using modified Merle d' Aubigne-Postel and Harris hip scoring. METHODS The current study is a prospective study in a tertiary referral centre where 8 young adult males were followed up for a period of 2 years 6 months from August 2018 to February 2021 after safe surgical dislocation and reduction with headless Herbert screws to maintain congruent hip surface. RESULTS We had 1 patient with associated chest injury requiring intercostal tube placement, while none of them had developed avascular necrosis or early arthritis. We had used modified Merle d'Aubigne-Postel and Harris hip scoring to assess the functional outcome. We had six patients with excellent results and two patients with good outcome due to occasional pain. We followed all the patients for more than 2 years. We evaluated the radiological and functional outcomes. The results are comparable to other researcher’s studies. CONCLUSIONS Safe surgical dislocation is a very good choice for fixation of femoral head fractures where the complications like early arthritis of femoral head and acetabulum are less along with preserving the vascularity of the femoral head and preventing the chances of avascular necrosis of femoral head. It also provides a good intraoperative view for handling the fracture reduction. KEYWORDS Pipkin Fracture, Ganz Approach, Safe Surgical Dislocation Hip, Herbert Screw

Extra-articular mini-open proximal phalanx osteotomy with retrograde intramedullary headless screw under WALANT — Surgical technical

We report on the surgical technique for mini-open derotation osteotomy using retrograde osteosynthesis by headless compression screw under WALANT anesthesia (video attached). Preoperative CT showed the feasibility of this technique, with a 2.2 mm headless compression screw. The mechanical stability of the resulting constructs combined with intraoperative active motion testing under WALANT authorized immediate rehabilitation without immobilization, thus preventing stiffness. Joint range of motion recovered by day 4 and bone consolidation was achieved at 30 days.

Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires.

The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.

Headless Compression Screw Fixation of Delayed Union Jones Fractures: A Case Series.

Different methods have been adopted to treat delayed union and non-union of fractures of the base of the fifth metatarsal using screws, plates and tension band wires. There has been increasing use of intramedullary screw fixation to treat these fractures with variable rates of success. The optimum screw diameter and properties have been a subject of debate. To assess the results of using a larger diameter 5.5 mm cannulated, headless variable-pitch screw to fix delayed union of Jones fracture of the base of the fifth metatarsal. A case series study including 24 patients with delayed union of Jones fifth meta-tar-sal fractures. The fractures were fixed by a 5.5 mm cannulated variable-pitch compression titanium screw (Acumed® Acutrak 2® Screw System). Radiological union was achieved in all patients at a mean of 7.2 weeks. At 12 months' follow up, patients had a mean American Orthopedic Foot & Ankle Society midfoot score of 95.6. The mean Short Form 12 Physical and mental survey scores improved from 22.71 and 29.31 points preoperatively to 57.88 and 59.54 respectively. The headless compression screw achieved a satisfactory union rate for delayed union Lawren-ce zone II fractures of the base of the fifth metatarsal with satisfactory functional results.

Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases.

Objective The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type). Methods Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018. Results The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5 th , 3 rd , and 2 nd (n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30° for the 2 nd and 3 rd metacarpals and > 40° for the 5 th metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240° and returned to their former occupations. All fractures consolidated and there were no reinterventions. Discussion The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost. Conclusion This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

BackgroundMetacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.ObjectiveWe propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.Materials and methodsWe used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.ResultsThe maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.ConclusionHeadless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Scaphoid Excision and Bicolumnar Carpal Fusion with Retrograde Headless Screws.

Background/Purpose Scaphoid excision and partial wrist fusion is used for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis. The purpose of this study was to report midterm functional and radiographic outcomes in a series of patients who underwent bicolumnar fusion of the lunocapitate and triquetrohamate joints using retrograde headless screws. Methods Twenty-three consecutive patients (25 wrists) underwent surgery with this technique from January 2014 to May 2017 with a minimum follow-up of 1 year. Assessment consisted of range of motion, grip, and pinch strength. Patient-reported outcome measures included disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores. Fusion rates and the radiolunate joint were evaluated radiographically. The relationship between wrist range of motion and midcarpal fusion angle (neutral position vs. extended capitolunate fusion angle > 20 degrees) was analyzed. Results Average follow-up was 18 months. Mean wrist extension was 41 degrees, flexion 36 degrees, and radial-ulnar deviation arc was 43 degrees. Grip strength was 39 kg and pinch 9 kg. Residual pain for activities of daily living was 1.6 (visual analog scale). The mean DASH and PRWE scores were 19 ± 16 and 28 ± 18, respectively. Patients with an extended capitolunate fusion angle trended toward more wrist extension but this did not reach statistical significance ( p = 0.17). Conclusions With retrograde headless compression screws, the proximal articular surface of the lunate is not violated, preserving the residual load-bearing articulation. Patients maintained a functional flexion-extension arc of motion with grip-pinch strength close to normal. Capitolunate fusion angle greater than 20 degrees may provide more wrist extension but further studies are needed to demonstrate this. Level of Evidence This is a Level IV study.

Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up.

Surgical treatment of extra-articular metacarpal and phalangeal fractures should be considered when there is instability or in patients with high demand. To overcome the issues related to the use of Kirschner wires, external fixators, and open reduction and internal fixation procedures, intramedullary headless screw fixation (IHSF) is an alternative technique to achieve primary fracture stability and early return to daily activities. We report the data of the Italian Multicentric Intra-Medullary Experience, which includes 173 cases of extra-articular unstable fractures (38 phalanges and 135 metacarpals) treated with the IHSF. After surgery, patients underwent early mobilization without splinting. The results confirm the reliability of IHSF in cases with non-articular involvement, showing a good recovery rate in terms of bone healing and range of motion.Level of evidence: IV.

Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review.

This systematic review was conducted to evaluate the retro-auricular trans-meatal approach (RA) to mandibular head fractures. Fractures of the mandibular head (8%) are a specific type of mandibular condyle fractures (34%). Despite numerous complications of conservative treatment, e.g., limited mobility and even ankylosis of the temporomandibular joint, as well as shortening of the mandibular ramus resulting in malocclusion, surgical intervention in this type of fracture is still problematic. The main problems with the dominant pre-auricular approach are the high risk of paralysis of the facial nerve and persistence of a visible scar. An attractive alternative is RA, which, despite its long history, has been described in English very few times, i.e., in only two clinical trials described in three articles in the last 21 years. According to these studies, RA gives a minimum of 90% of ideal positions of bone fragments and an always fully preserved function of the facial nerve in the course of long-term observation. RA allows the application of long screws for fixation, which provide good stabilization. In addition, new types of headless screws leave a smooth, non-irritating bone surface, and the immediate future may be dominated by their resorbable varieties. RA can, therefore, be treated as a very favorable access to fractures of the mandibular head, especially due to the protection of the facial nerve and the possibility of providing a stable and predictable fixation.

Change in Pull-Out Force during Resorption of Magnesium Compression Screws for Osteosynthesis of Mandibular Condylar Fractures.

Background: Magnesium has been used as degradable fixation material for osteosynthesis, but it seems that mechanical strength is still a current issue in these fixations. The aim of this study was to evaluate the axial pull-out force of compression headless screws made of magnesium alloy during their resorption. Methods: The tests included screws made for osteosynthesis of the mandible head: 2.2 mm diameter magnesium alloy MgYREZr (42 screws) and 2.5 mm diameter polylactic-co-glycolic acid (PLGA) (42 pieces, control). The screws were resorbed in Sørensen’s buffer for 2, 4, 8, 12, and 16 weeks, and force was measured as the screw was pulled out from the polyurethane block. Results: The force needed to pull the screw out was significantly higher for MgYREZr screws than for PLGA ones (p < 0.01). Within eight weeks, the pull-out force for MgYREZr significantly decreased to one third of its initial value (p < 0.01). The dynamics of this decrease were greater than those of the pull-out force for PLGA screws (p < 0.05). After these eight weeks, the values for metal and polymer screws equalized. It seems that the described reduction of force requires taking into account when using magnesium screws. This will provide more stable resorbable metallic osteosynthesis.

In vitro Biomechanical Analysis of Proximal Phalangeal Osteotomy Fixation.

Background Corrective osteotomies of the proximal phalanx are typically stabilized with plate and screws. Although intramedullary headless screws form an alternative fixation method in the treatment of acute phalangeal fractures, reports about fixation of opening wedge corrective osteotomies with these implants are lacking. Objective The goal of the present study was to biomechanically compare the failure force of both fixation methods for this specific indication. Methods Twenty-four cadaver phalanges were equally distributed between apex volar and apex lateral opening wedge osteotomy groups. In each group, half of the osteotomies were fixed with a 1.3-mm dorsal locking plate, the other half with a 2.4-mm intramedullary headless screw. A three-point bending test was performed. Results The mean maximal failure force after apex lateral osteotomy was 178.4 N for the plate-screw construct and 144.0 N after intramedullary headless screw fixation. After apex volar osteotomy, mean maximal force was 237.6 N in the plate-screw group and 160.9 N in the intramedullary headless screw group. Mean stiffness after apex lateral osteotomy was 63.3 N/mm in the plate-screw group, and 55.9 N/mm in the intramedullary headless screw group. Mean stiffness after apex volar osteotomy was 197.5 N/mm and 60.0 N/mm for the plate-screw and intramedullary headless screw group, respectively. Conclusion For apex volar osteotomies, dorsally applied angular stable plate and screws provide significantly stronger fixation than intramedullary headless screws. For apex lateral osteotomies, fixation force is comparable. Clinical relevance These data are useful when considering fixation of opening wedge osteotomies with intramedullary screws.

Cost of Headless vs Headed Screw Fixation for Calcaneal Osteotomy and Subtalar Arthrodesis.

Background:Screw head prominence in the heel following fixation for calcaneal osteotomy or subtalar arthrodesis has resulted in high rates of symptomatic hardware and screw removal. A cost analysis was performed to determine the financial implications of screw removal. Furthermore, we compared the rate of nonunion following fixation.Methods: Current Procedural Terminology codes were used to identify all patients who had a subtalar arthrodesis or calcaneal osteotomy (with screw fixation) performed between 2010 and 2016. The cohort was divided into 2 groups: 7.0-mm headless screw or 6.7-mm headed screw. The primary outcome measure was the rate of symptomatic screw removal. Secondary outcomes included the rate of nonunion. The expense associated with symptomatic hardware removal was determined by cost analysis.Results:Seventy-six patients underwent headless screw fixation, and 2 patients (2.6%) required screw removal. Fifty-four patients underwent headed screw fixation and 12 patients (22.2%) required screw removal. Symptomatic hardware removal was performed more frequently in the headed screw group (P < .001). There was no difference in the rate of nonunion after subtalar arthrodesis between the 2 groups (P = .363). The calcaneal osteotomy united in 100% of patients. There was a $51 755 cost savings per 100 cases using headless screw fixation.Conclusion:The rate of symptomatic screw removal was lower with headless screw fixation. The calcaneal osteotomy healed in 100% of patients, and there was no difference in the rate of subtalar nonunion between the 2 groups. Cost analysis demonstrated a significant benefit when the expense of hardware removal was considered.Level of Evidence:Level III, retrospective cohort study.

Intramedullary Headless Screw Fixation of Distal Metacarpal Fractures – the Birmingham Experience

Background: Surgical fixation using intramedullary headless screws (IHS) is a relatively new technique for metacarpal fracture repair. However, there are very few studies investigating the outcomes of this procedure. We present the surgical and functional outcomes of a consecutive series of 30 metacarpal fractures treated by a single surgeon over a 2.5-year period using IHS. Methods: We retrospectively reviewed the records of 30 metacarpal fractures in 27 patients who underwent IHS fixation from March 2016 to October 2018. There were 29 fractures of the metacarpal neck and 1 was to the metacarpal head. All fractures underwent the procedure by a single operating surgeon. Individual joint movements along with total active movement (TAM) was measured at postoperative follow-up appointments 4-8 weeks after surgery. Fracture healing was confirmed with plain radio-graphs. Patients were also recalled in March 2019 for their latest functional measurements. A QuickDASH (disabilities of the arm, shoulder and hand) questionnaire was used to assess for any residual functional disability. Results: All fractures healed within acceptable radiological parameters with no mal-unions or rotational deformities. The average TAM at initial follow-up was 245°, which improved to 264° at the March 2019 review. All patients returned to work in an average of 6 weeks. The final functional QuickDASH score was an average of 2.9/100 (range 0-18.2). 2/27 patients required further surgery for stiffness before regaining excellent TAM. No patient required metalwork removal. There were no other complications. Conclusions: Our findings suggest that IHS fixation is an effective alternative technique for the treatment of metacarpal fractures. It is a relatively simple procedure, which provides good stable fixation, allowing for early mobilisation. It has few complications and does not routinely require removal of the implant.

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

BackgroundSurgical treatment is necessary for scaphoid nonunion. Open surgery with a combined volar and dorsal approach is thought to have poor functional outcomes and a prolonged recovery course. However, the detailed recovery course for this approach is rarely reported. The aim of this study was to investigate the recovery course and radiographic outcome for patients with scaphoid nonunion who underwent a combined volar bone grafting and dorsal antegrade headless screw approach.Material and methodsEighteen patients with scaphoid nonunion who underwent combined volar bone grafting and dorsal antegrade headless screw fixation were enrolled in this retrospective study. Preoperative and serial postoperative wrist functional and radiographic outcomes were collected and analysed.ResultsAll 18 patients achieved bone union at a mean time of 14.3 weeks. Compared to the preoperative status, the grip strength, wrist motion arc, and Mayo Wrist score were improved significantly 6 months after surgery, whilst the Disabilities of the Arm, Shoulder, and Hand (DASH) score did not recover until 12 months after surgery. Significant improvements were found in all scaphoid radiographic parameters.ConclusionThe surgical outcomes for scaphoid nonunion treated with a combined volar bone grafting and dorsal antegrade headless screw achieved a high union rate, with great wrist functional and radiographic outcomes. The earliest recovered wrist functional parameters were grip strength, motion arc, Mayo Wrist score and finally the DASH score at postoperative 6 months and 12 months, respectively.

Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius.

The treatment of delayed union and established nonunion of the scaphoid using a volar approach with impaction of bone graft, either a cancellous or cortico-cancellous wedge graft, for osteosynthesis and maintenance of reduction. With the advancement of instruments and techniques of wrist arthroscopy, wider indications for wrist problems can be solved by this minimally invasive technique. We report our results of arthroscopic reduction, cancellous bone grafting to the regional distal radius, and headless screw fixation for the treatment of scaphoid nonunion, even with humpback deformity. Between August 2014 and February 2018, 41 patients (42 wrists) with unstable scaphoid nonunion received arthroscopic surgery. The mean follow-up was 38.1months (range 24-70months). We evaluated the results with a function questionnaire and clinical outcomes based on the visual analog scale (VAS) pain score, range of motion and grip strength, and radiologic measurements. The union rate was 92.6% (38/41 patients) and union time was 4.6months. Patients regained almost a full range of motion compared with the contralateral wrist. The post-op Quick DASH, Mayo wrist score, and VAS pain score all had significant improvement, with p < 0.05. The scapholunate angle showed significant correction from pre-op 68.0° to post-op 58.3°. The average VAS satisfaction score at final follow-up was 8.7. Arthroscopic realignment and osteosynthesis for the treatment of unstable scaphoid nonunion with ipsilateral radius bone graft, even with humpback deformity, can achieve a high union rate, good radiological correction, and good functional recovery.

Traumatic bilateral scaphoid fractures.

Aim To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture. Methods We came across a young student, who sustained bilateral, undisplaced scaphoid waist fractures following a fall during a football match. Despite careful clinical and radiographic evaluation by four views at the Accident and Emergency (A&E) Department, we initially performed only the diagnosis of the left scaphoid fracture treating it with a percutaneous Acutrack headless screw. Eight months later this patient returned to the A&E department due to a new trauma to his right wrist with the onset of painful symptoms: cystic scaphoid non-union. No pain had been reported on the wrist in those months. Results We performed osteosynthesis with Herbert headless screw through an extended volar approach placing a non-vascularized cortico-spongious bone grafts taken from radius. Periodic follow up by clinical examination, X-ray and CT scan with evidence of bone healing was performed. Conclusion Bilateral scaphoid fractures are rarely encountered, mostly as stress fractures in athletes and manual workers. If left untreated, arthritis, deformity, and instability can lead to significant disability. Comprehensive imaging should be done in case of suspected scaphoid fractures, especially after a trauma, even in the presence of modest symptoms, as failure to do so may lead to missed fracture. Considering what was exposed, the radiographic check on the right wrist repeated about two weeks after the trauma would have avoided a missed diagnosis, even in the absence of reported clinical symptoms. We therefore recommend to repeat the radiographic examination in all situations like these.

Headless vs. Headed Screws Fixation for Calcaneal Osteotomy and Subtalar Arthrodesis: What’s the Cost?

Category:Hindfoot; Ankle ArthritisIntroduction/Purpose:Screw prominence in the heel following calcaneal fixation has resulted in unacceptably high rates of symptomatic hardware and subsequent screw removal. The hardware removal rate following calcaneal screw fixation ranges from 11-50%. We are unaware of any cost analysis comparing headed screw fixation vs. headless screw fixation in the foot and ankle literature. Furthermore, there is no literature comparing the rate of subtalar arthrodesis following headed screw fixation vs. headless screw fixation.Methods:CPT codes were used to identify all patients that had a subtalar arthrodesis or displacement calcaneal osteotomy (with screw fixation) performed by a single orthopedic foot and ankle surgeon between 2010 and 2016. The cohort was divided into two groups by the type of screw fixation, 7.0 mm headless screw or 6.7 mm headed screw. Exclusion criteria included <2 years from the index surgery and AVN of the calcaneus or talus. Retrospective chart review was performed to collect demographic data, complications, and cause for screw removal. The primary outcome measure was the rate of symptomatic screw removal.Secondary outcome measure included subtalar arthrodesis as determined by CT or radiographic review. The expense associated with symptomatic hardware removal was determined and cost analysis was performed for the two groups.Results:Seventy-six patients underwent headless screw fixation for calcaneal osteotomy or subtalar arthrodesis, and only two patients (2.6%) required symptomatic screw removal. Fifty-four patients underwent headed calcaneal screw fixation, and twelve patients (22.2%) required symptomatic screw removal. Symptomatic hardware removal was performed more frequently in the headed screw group (p< 0.001). There was no difference in the rate of nonunion after subtalar arthrodesis between the two groups (p = 0.363). The calcaneal osteotomy healed in 100% of patients in both groups. The cost associated with isolated screw removal was compared for private insurance and Medicare at an outpatient surgery center. There was a $51,755 cost savings per 100 cases using headless screw fixation compared to headed screw fixation.Conclusion:The rate of symptomatic screw removal following calcaneal osteotomy or subtalar arthrodesis is lower with headless screw fixation compared to headed screw fixation. There was no difference in the rate of subtalar union between the two groups as a secondary outcome, but the study was underpowered. Although the headless screw implant is more expensive, cost analysis demonstrates a significant benefit when the expense of hardware removal is considered.

Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique

Category:Sports; Lesser ToesIntroduction/Purpose:Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system.Methods:Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated.Results:Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed.Conclusion:Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.

Results of Percutaneous Fixation of Acute Scaphoid Fractures by Herbert Screw

Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.

Results of Percutaneous Fixation of Acute Scaphoid Fractures by Herbert Screw

Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.