Le système VB est un nouveau matériel d'ostéosynthèse des petits fragments qui combine les avantages des broches et des vis en un seul matériel modulaire. Après mise en place de la broche, une bague perforée (filetée ou non) stabilisant la deuxième corticale, est solidarisée sur la broche. Ces deux éléments deviennent ainsi un dispositif monobloc, assurant une synthèse aussi stable qu'avec une vis. Ce système est d'utilisation facile, peut être ajusté à la longueur exacte, permet une ostéosynthèse statique, en compression ou en distraction. Le libre glissement de la bague sur la broche avant sa solidarisation permet à l'opérateur de régler manuellement le degré de compression ou de distraction de l'ostéosynthèse.

VB is an osteosynthesis system for the stabilisation of small fragments, which combines the benefits of both wires and screws. It is a modular system comprising a threaded pin and a ring. The threaded pin is first positioned. Then a ring is grasped and opened by the progressive angulation of a screwdriver. Still anchored on the screwdriver, the ring slides easily on the pin. It is clamped on the pin by simply removing the screwdriver and the pin is then cut. This modular system includes 1,8 and 1,1 mm pins and different types of rings (threaded or non threaded, with or without collars). The system is easy to handle and can be introduced using an open or percutaneous technique, allowing compression or distraction. Our preliminary series, performed in accordance with National clinical trial protocol (Huriet) consisted of 50 cases in 24 patients (five women and 19 men) with an average age of 48 years, and a follow-up of more than six months. Fourteen cases of fractures (28 implants) were treated as emergencies (two radial heads, one capitellum, one trochlea of the humerus, seven distal radius fractures, one trapezium, two metacarpals) and 12 cases (22 implants) were elective cases: arthrodesis (one trapezo-metacarpal, one intermetacarpal, two interphalangeal, two carpal), non-union (six scaphoids, one phalangeal) and one phalangeal malunion. Hardware removal was performed in 16 cases. No implant failure has been detected. One case, a DIP arthrodesis, had a suspicion of sepsis which led to the removal of the implants at six weeks. The results of this study have convinced us of the merits of the system, which combines the advantages of both wires and screws. The system allows the user to perform either distraction or compression, and to adjust the force by hand. Compared to the fixed amount of compression produced by lag screws, this feature seems to be a real step forward.