Herbert screw fixation of a Salter Harris type III epiphyseal injury of the radial head

Extended uses for the Herbert/Whipple screw: six case reports out of 35 illustrating technique

We have used 6.5-mm and 4.5-mm Herbert/Whipple screws in our Trauma Center since 1991. This double-threaded headless device is used primarily in the scaphoid to manage fractures and delayed unions, but can be used successfully to fixate other fractures at diverse sites. In reviewing our experience, we will discuss several characteristics of this screw. These include advantages of the screw, such as generation of only minor soft-tissue trauma in areas of poor soft-tissue coverage or for transcartilaginous fixation, as well as its disadvantages, such as weak interfragmentary compression and low pullout resistance. Case reports are presented to illustrate applications of this device in the upper extremity (fractures of the humeral neck, the articular surface of the shoulder blade, and pseudarthrosis of the olecranon) and in the lower extremity (fractures of the talar neck, the medial malleolus, and Volkmann's triangle).

[Expanded indications for the Herbert-screw osteosynthesis]

Since 1984 the typical headless double threaded Herbert/Whipple screw is known in managing scaphoid fractures and scaphoid non-unions. We resume technical, biomechanical and histological aspects to point out advantages and disadvantages of this osteosynthesis. Our case review of 39 patients illustrate the same good results as achieved in treating scaphoid injuries, when using the Herbert/Whipple screw of a larger diameter for expanded indications other than scaphoid fractures, such as humeral- or radial-head fractures, Jones fractures and others.