Herbert classification

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The Herbert classification is a system of categorizing scaphoid fractures. [1]

Contents

Classification

TypeDescription
AAcute/stableA1 Tubercle
A2Nondisplaced waist crack
BAcute/unstableB1Oblique/distal third
B2Displaced waist
B3Proximal pole
B4Fracture dislocation
B5 Comminuted fracture
CDelayed union
DEstablished non-unionD1Fibrous
D2Sclerotic

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<span class="mw-page-title-main">Wrist</span> Part of the arm between the lower arm and the hand

In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

<span class="mw-page-title-main">Anatomical snuffbox</span> Indent on back of hand between tendons

The anatomical snuff box or snuffbox or foveola radialis is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor. The name originates from the use of this surface for placing and then sniffing powdered tobacco, or "snuff." It is sometimes referred to by its French name tabatière.

<span class="mw-page-title-main">Trapezoid bone</span> Carpal (wrist) bone

The trapezoid bone is a carpal bone in tetrapods, including humans. It is the smallest bone in the distal row of carpal bones that give structure to the palm of the hand. It may be known by its wedge-shaped form, the broad end of the wedge constituting the dorsal, the narrow end the palmar surface; and by its having four articular facets touching each other, and separated by sharp edges. It is homologous with the "second distal carpal" of reptiles and amphibians.

<span class="mw-page-title-main">Scaphoid bone</span> Bone of the carpus

The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist. It forms the radial border of the carpal tunnel. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. It is approximately the size and shape of a medium cashew nut.

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The capitate bone is a bone in the human wrist found in the center of the carpal bone region, located at the distal end of the radius and ulna bones. It articulates with the third metacarpal bone and forms the third carpometacarpal joint. The capitate bone is the largest of the carpal bones in the human hand. It presents, above, a rounded portion or head, which is received into the concavity formed by the scaphoid and lunate bones; a constricted portion or neck; and below this, the body. The bone is also found in many other mammals, and is homologous with the "third distal carpal" of reptiles and amphibians.

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The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is usually slightly longer than the radius, but the radius is thicker. Therefore the radius is considered to be the larger of the two. It is a long bone, prism-shaped and slightly curved longitudinally.

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

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The radial styloid process is a projection of bone on the lateral surface of the distal radius bone.

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A scaphoid fracture is a break of the scaphoid bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.

<span class="mw-page-title-main">Preiser disease</span> Medical condition

Preiser disease, or (idiopathic) avascular necrosis of the scaphoid, is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture. It is thought to be caused by repetitive microtrauma or side effects of drugs in conjunction with existing defective vascular supply to the proximal pole of the scaphoid. MRI coupled with CT and X-ray are the methods of choice for diagnosis.

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The Herbert screw is a variable pitch cannulated screw typically made from titanium for its biocompatible properties as the screw is normally intended to remain in the patient indefinitely. It became generally available in 1978. It is one of the earliest designs of headless compression screws which are used to achieve interfragmentary compression through its differential pitch between the threads at each end of the screw(distance between adjacent threads of screw).

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Wrist osteoarthritis is a group of mechanical abnormalities resulting in joint destruction, which can occur in the wrist. These abnormalities include degeneration of cartilage and hypertrophic bone changes, which can lead to pain, swelling and loss of function. Osteoarthritis of the wrist is one of the most common conditions seen by hand surgeons.

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An occult fracture is a fracture that is not readily visible, generally in regard to projectional radiography ("X-ray"). Radiographically, occult and subtle fractures are a diagnostic challenge. They may be divided into 1) high energy trauma fracture, 2) fatigue fracture from cyclical and sustained mechanical stress, and 3) insufficiency fracture occurring in weakened bone. Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Advanced imaging tools such as computed tomography, magnetic resonance imaging (MRI), and scintigraphy are highly valuable in the early detection of these fractures.

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References

  1. Krimmer H, Schmitt R, Herbert T (2000). "Scaphoid fractures - diagnosis, classification and therapy". Unfallchirurg. 103 (10): 812–9.