Comparison of Herbert and Acutrak screws in the treatment of scaphoid non-union and delayed union.

A retrospective analysis was performed on patients who had undergone surgery for delayed union or non-union of a scaphoid fracture. This was conducted to investigate if there was a difference in outcome between patients treated with the Acutrak screw or the Herbert screw. Twenty two cases were treated with a Herbert screw and 23 with an Acutrak screw. The patient demographics, aetiology of injury and fracture types were similar between the two groups. There was no significant difference in union rate or time to union for fractures treated with the Herbert screw or the Acutrak screw. There appears to be no difference in outcome for cases of scaphoid fracture delayed union and non-union treated with either the Herbert screw or the Acutrak screw.

Internal fixation of proximal humeral fractures.

We discuss the appropriate assessment and treatment options available for proximal humeral fractures. Important factors to consider are the fracture pattern, the bone quality and any co-morbidities. These are common injuries and are increasing in incidence due to an ageing population. The management of displaced 3- and 4-part fractures remains controversial. The ideal is anatomic reduction and stable internal fixation of the fractures especially the tuberosities to allow early mobilisation. The recent introduction of fixed angle locking plates allows stable fixation even in markedly osteoporotic bone. The early results are encouraging however there are presently no randomised trials comparing these devices to conservative treatment, conventional plating or hemiarthroplasty.