CLINICAL RESEARCH OF INDIVIDUAL PERCUTANEOUS CANNULATED SCREWS FIXATION FOR TREATMENT OF Herbert TYPE Ib SCAPHOID FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENGJun ,  LINXu , ZHONGZeli , TANLun

Department of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P. R. China;

Corresponding?author：

LINXu, Email: Med_linxu@163.com

Keywords：

Scarpal scaphoid fracture; Percutaneous cannulated screws fixation; Three-dimensional guide plate; Minimally invasive surgery

DOI：

10.7507/1002-1892.20160244

Video：

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Objective To investigate the effectiveness of individual percutaneous cannulated screws fixation of computer-assisted design combined with three-dimensional (3D) guide plate by comparing with cast immobilization and open internal fixation for treatment of Herbert type Ib scaphoid fracture. Methods Between January 2010 and June 2015, 56 patients with fresh Herbert type Ib scaphoid fracture were treated with cast immobilization in 16 cases (external fixation group), with open reduction and internal fixation in 20 cases (open reduction group), and with individual percutaneous cannulated screws fixation of computer-assisted design combined 3D guide plate in 20 cases (minimal invasion group). There was no significant difference in gender, age, injury cause, side, disease duration, and classification of fractures between groups P>0.05).The time of bone union, bone nonunion rate, return-to-work time, wrist range of motion (ROM), and Mayo function score were recorded and compared. Results Primary healing of incision was obtained in open reduction group and minimally invasion group, without related complications. The cases were followed up 10-24 months (mean, 16.6 months). The time of bone union and return-to-work time of minimal invasion group were significantly shorter than those of the other 2 groups (P<0.05), and the rate of bone nonunion was significantly lower than that of the other 2 groups (P<0.05). At last follow-up, the wrist ROM of minimal invasion group[(104.40±3.46)°] was significantly larger than that of external group[(94.20±2.42)°] and open reduction group[(96.40±2.66)°] (P<0.05). According to Mayo function score, the results were excellent in 6 cases, good in 5 cases, fair in 2 cases, and poor in 3 cases in external fixation group, with an excellent and good rate of 69%; the results were excellent in 9 cases, good in 7 cases, fair in 2 cases, and poor in 2 cases in open reduction group, with an excellent and good rate of 80%; the results were excellent in 16 cases, good in 3 cases, and fair in1 case in minimal invasion group, with an excellent and good rate of 95%; there was significant difference in excellent and good rate among groups (P<0.05). Conclusion Individual percutaneous cannulated screws fixation of computer-assisted design combined with 3D guide plate has satisfactory effectiveness in the treatment of Herbert type Ib scaphoid fractures, with the advantages of mini-invasion, high accuracy, high rate of bone union, less complication, early return-to-work time.

Citation： ZENG Jun, LIN Xu, ZHONG Zeli, TAN Lun. CLINICAL RESEARCH OF INDIVIDUAL PERCUTANEOUS CANNULATED SCREWS FIXATION FOR TREATMENT OF Herbert TYPE Ib SCAPHOID FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1189-1194. doi: 10.7507/1002-1892.20160244 Copy

1.	Kozin SH. Incidence, mechanism, and natural history of scaphoid fracturs. Hand Clin, 2001, 17(4):515-524.
2.	Buijze GA, Goslings JC, Rhemrev SJ, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures:a multicenter, randomized, controlled trial. J Hand Surg (Am), 2014, 39(4):621-627.
3.	Burnba?irevi? M, Tomi? S, Le?i? A, et al. The treatment of scaphoid nonunion using the Ilizarov fixatior without bone graft, a study of 18 cases. J Orthop Surg Res, 2011, 6:57-66.
4.	陳孝平, 石應康, 邱貴興, 等. 外科學. 2版. 北京:人民衛生出版社, 2005:904.
5.	Bedi A, Jebson PJ, Hayden RJ, et al. Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach:an assessment of radiographic and functional outcomes. J Hand Surg (Am), 2007, 32(3):326-333.
6.	Modi CS, Nancoo T, Powers D, et al. Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures-a systematic review. Injury, 2009, 40(3):268-273.
7.	Sch?del-H?pfner M, Marent-Huber M, Gazyakan E, et al. Actue non-displaced fractures of the scaphoid:earlier return to activities after operation treatment. A controlled multicenter cohort study. Arch Orthop Trauma Surg, 2010, 130(9):1117-1127.
8.	Garcia RM, Ruch DS. Management of scaphoid fractures in the athlete:open and percutaneous fixation. Sports Med Arthrosc, 2014, 22(1):22-28.
9.	劉波, 陳山林, 劉暢, 等. 計算機導航輔助舟骨骨折微創內固定的初步研究. 中華顯微外科雜志, 2014, 37(6):553-556.
10.	Kam CC, Greenberg JA. Computer-assisted navigation for dorsal percutaneous scaphoid screw placement:a cadaveric study. J Hand Surg (Am), 2014, 39(4):613-620.
11.	Mavili ME, Canter HI, Saglam-Aydinatay B, et al. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgey. J Craniofac Surg, 2007, 18(4):740-747.
12.	Dodds SD, Panjabi MM, Slade JF 3rd. Screw fixation of scaphoid fractures:a biomechanical assessment of screw length and screw augmentation. J Hand Surg (Am), 2006, 31(3):405-413.
13.	Kurahashi T, Shinohara T, Hirata H. Modified dorsal percutaneous screw fixation through a transtrapezial approach for scaphoid fractures. J Hand Surg (Eur Vol), 2015, 40(8):868-869.
14.	Verstreken F, Meermans G. Transtrapezial approach for fixation of acute scaphoid fractures:rationale, surgical techniques, and result. J Bone Joint Surg (Am), 2015, 97(10):850-858.
15.	Geurts GF, Van Riet RP, Meermans G, et al. Volar percutaneous transtrapezial fixation of scaphoid waist fractures:surgical technique. Acta Orthop Belg, 2012, 78(1):121-125.
16.	Evans S, Brantley J, Brady C, et al. Structures at risk during volar percutaneous fixation of scaphoid fractures:a cadaver study. Iowa Orthop J, 2015, 35:119-123.
17.	樊志強, 徐永清, 李晶, 等. 正常腕關節運動時腕中關節運動學在體研究. 中國臨床解剖學雜志, 2009, 27(1):5-8.
18.	喻林波, 李曉文, 歐春培, 等. 腕橈背側入路與腕掌側入路治療腕舟骨骨折對骨折愈合影響的比較. 貴陽中醫學院學報, 2013, 35(1):154-156.
19.	Drac P, Cizmar I, Manak P, et al. Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study. Biomed Pap Med Fac Univ Palacky Olomauc Czech Repub, 2014, 158(2):277-281.

1. Kozin SH. Incidence, mechanism, and natural history of scaphoid fracturs. Hand Clin, 2001, 17(4):515-524.
2. Buijze GA, Goslings JC, Rhemrev SJ, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures:a multicenter, randomized, controlled trial. J Hand Surg (Am), 2014, 39(4):621-627.
3. Burnba?irevi? M, Tomi? S, Le?i? A, et al. The treatment of scaphoid nonunion using the Ilizarov fixatior without bone graft, a study of 18 cases. J Orthop Surg Res, 2011, 6:57-66.
4. 陳孝平, 石應康, 邱貴興, 等. 外科學. 2版. 北京:人民衛生出版社, 2005:904.
5. Bedi A, Jebson PJ, Hayden RJ, et al. Internal fixation of acute, nondisplaced scaphoid waist fractures via a limited dorsal approach:an assessment of radiographic and functional outcomes. J Hand Surg (Am), 2007, 32(3):326-333.
6. Modi CS, Nancoo T, Powers D, et al. Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures-a systematic review. Injury, 2009, 40(3):268-273.
7. Sch?del-H?pfner M, Marent-Huber M, Gazyakan E, et al. Actue non-displaced fractures of the scaphoid:earlier return to activities after operation treatment. A controlled multicenter cohort study. Arch Orthop Trauma Surg, 2010, 130(9):1117-1127.
8. Garcia RM, Ruch DS. Management of scaphoid fractures in the athlete:open and percutaneous fixation. Sports Med Arthrosc, 2014, 22(1):22-28.
9. 劉波, 陳山林, 劉暢, 等. 計算機導航輔助舟骨骨折微創內固定的初步研究. 中華顯微外科雜志, 2014, 37(6):553-556.
10. Kam CC, Greenberg JA. Computer-assisted navigation for dorsal percutaneous scaphoid screw placement:a cadaveric study. J Hand Surg (Am), 2014, 39(4):613-620.
11. Mavili ME, Canter HI, Saglam-Aydinatay B, et al. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgey. J Craniofac Surg, 2007, 18(4):740-747.
12. Dodds SD, Panjabi MM, Slade JF 3rd. Screw fixation of scaphoid fractures:a biomechanical assessment of screw length and screw augmentation. J Hand Surg (Am), 2006, 31(3):405-413.
13. Kurahashi T, Shinohara T, Hirata H. Modified dorsal percutaneous screw fixation through a transtrapezial approach for scaphoid fractures. J Hand Surg (Eur Vol), 2015, 40(8):868-869.
14. Verstreken F, Meermans G. Transtrapezial approach for fixation of acute scaphoid fractures:rationale, surgical techniques, and result. J Bone Joint Surg (Am), 2015, 97(10):850-858.
15. Geurts GF, Van Riet RP, Meermans G, et al. Volar percutaneous transtrapezial fixation of scaphoid waist fractures:surgical technique. Acta Orthop Belg, 2012, 78(1):121-125.
16. Evans S, Brantley J, Brady C, et al. Structures at risk during volar percutaneous fixation of scaphoid fractures:a cadaver study. Iowa Orthop J, 2015, 35:119-123.
17. 樊志強, 徐永清, 李晶, 等. 正常腕關節運動時腕中關節運動學在體研究. 中國臨床解剖學雜志, 2009, 27(1):5-8.
18. 喻林波, 李曉文, 歐春培, 等. 腕橈背側入路與腕掌側入路治療腕舟骨骨折對骨折愈合影響的比較. 貴陽中醫學院學報, 2013, 35(1):154-156.
19. Drac P, Cizmar I, Manak P, et al. Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study. Biomed Pap Med Fac Univ Palacky Olomauc Czech Repub, 2014, 158(2):277-281.

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Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL RESEARCH OF INDIVIDUAL PERCUTANEOUS CANNULATED SCREWS FIXATION FOR TREATMENT OF Herbert TYPE Ib SCAPHOID FRACTURE

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