Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Xiaohui , WANG Qingfeng , ZHANG Caili , SHEN Suhong , LI Wuyin

Department of Hand Microsurgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China;

Corresponding?author：

WANG Xiaohui, Email: 963099784@qq.com

Keywords：

Carpal scaphoid fractures; percutaneous fixation; ultrasonography

DOI：

10.7507/1002-1892.201802023

Video：

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Objective To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Methods Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. Results The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Conclusion Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.

Citation： WANG Xiaohui, WANG Qingfeng, ZHANG Caili, SHEN Suhong, LI Wuyin. Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 989-992. doi: 10.7507/1002-1892.201802023 Copy

1.	Alnaeem H, Aldekhayel S, Kanevsky J, et al. A Systematic review and meta-analysis examining the differences between nonsurgical management and percutaneous fixation of minimally and nondisplaced scaphoid fractures. J Hand Surg (Am), 2016, 41(12): 1135-1144. e1.
2.	蔣繼樂, 劉波, 陳山林, 等. 掌、背側入路經皮加壓螺釘內固定治療急性舟骨腰部骨折. 中華骨科雜志, 2016, 36(14): 898-905.
3.	曾俊, 林旭, 鐘澤蒞, 等. 個體化經皮空心螺釘內固定治療 Herbert Ⅰb 型腕舟骨骨折的臨床研究. 中國修復重建外科雜志, 2016, 30(10): 1189-1194.
4.	Krimmer H, Schmitt R, Herbert T. Scaphoid fractures--diagnosis, classification and therapy. Unfallchirurg, 2000, 103(10): 812-829.
5.	蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京: 人民衛生出版社, 2005: 33-34.
6.	劉偉, 趙勁民, 蘇偉, 等. 經皮螺釘置入固定與石膏固定治療急性無移位性腕舟骨骨折的系統評價. 中國組織工程研究, 2012, 16(13): 2384-2388.
7.	陳斌, 徐永清, 李晶, 等. 腕舟骨骨折三維運動學在體實驗研究. 中華手外科雜志, 2009, 25(6): 365-368.
8.	路來金. 亟待提高腕舟骨骨折的整體診治水平. 中華手外科雜志, 2016, 32(2): 81-82.
9.	傅重洋, 丁暉原, 趙巍, 等. 應用注射器針導引掌側經皮 Bold 空心螺釘固定腕舟骨骨折. 中華手外科雜志, 2014, 30(3): 188-190.
10.	Taleb C, Bodin F, Collon S, et al. Retrograde percutaneous screw fixation for scaphoid type Ⅱ non-union in Schernberg zones 2 to 4: a series of 38 cases. Chir Main, 2015, 34(1): 32-38.
11.	孫勇偉, 張蜀華. CT 引導下經皮 Herbert 螺釘微創治療腕舟骨骨折 21 例報告. 中國微創外科雜志, 2014, 14(7): 644-646, 657.
12.	林旭, 曾俊, 郭勇, 等. 計算機輔助設計個體化腕舟骨重建: 指導經皮空心釘置入內固定修復. 中國組織工程研究, 2014, 18(44): 7178-7182.
13.	Yin HW, Xu J, Xu WD. 3-Dimensional printing-assisted percutaneous fixation for acute scaphoid fracture: 1-shot procedure. J Hand Surg (Am), 2017, 42(4): 301.e1-301.e5.
14.	Becciolini M, Bonacchi G. Fracture of the sesamoid bones of the thumb associated with volar plate injury: ultrasound diagnosis. J Ultrasound, 2015, 18(4): 395-398.
15.	Zhang GY, Zhuang HY, Wang LX. Value of high frequency ultrasonography in diagnosis and surgical repair of traumatic finger tendon ruptures. Med Princ Pract, 2012, 21(5): 472-475.
16.	Mohseny B, Nijhuis TH, Hundepool CA, et al. Ultrasonographic quantification of intrinsic hand muscle cross-sectional area; reliability and validity for predicting muscle strength. Arch Phys Med Rehabil, 2015, 96(5): 845-853.
17.	王孝輝, 沈素紅, 李德, 等. 超聲引導下閉合復位穿針固定治療成人指骨骨折. 中華超聲影像學雜志, 2016, 25(9): 804-807.
18.	王雷, 王孝輝, 李無陰. 超聲與 C 臂 X 線機引導閉合復位穿針固定治療掌指骨骨折的療效比較. 中國修復重建外科雜志, 2017, 31(10): 1179-1183.
19.	王孝輝, 張彩麗, 沈素紅, 等. 超聲引導下手法復位牽引托板固定治療掌骨頸骨折. 中國骨傷, 2018, 31(3): 254-256.
20.	沈素紅, 王孝輝, 付卓. 超聲引導下閉合復位微創固定治療掌指骨骨折. 中國醫學影像技術, 2018, 34(2): 293-296.
21.	Anas EM, Seitel A, Rasoulian A, et al. Registration of a statistical model to intraoperative ultrasound for scaphoid screw fixation. Int J Comput Assist Radiol Surg, 2016, 11(6): 957-965.

1. Alnaeem H, Aldekhayel S, Kanevsky J, et al. A Systematic review and meta-analysis examining the differences between nonsurgical management and percutaneous fixation of minimally and nondisplaced scaphoid fractures. J Hand Surg (Am), 2016, 41(12): 1135-1144. e1.
2. 蔣繼樂, 劉波, 陳山林, 等. 掌、背側入路經皮加壓螺釘內固定治療急性舟骨腰部骨折. 中華骨科雜志, 2016, 36(14): 898-905.
3. 曾俊, 林旭, 鐘澤蒞, 等. 個體化經皮空心螺釘內固定治療 Herbert Ⅰb 型腕舟骨骨折的臨床研究. 中國修復重建外科雜志, 2016, 30(10): 1189-1194.
4. Krimmer H, Schmitt R, Herbert T. Scaphoid fractures--diagnosis, classification and therapy. Unfallchirurg, 2000, 103(10): 812-829.
5. 蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京: 人民衛生出版社, 2005: 33-34.
6. 劉偉, 趙勁民, 蘇偉, 等. 經皮螺釘置入固定與石膏固定治療急性無移位性腕舟骨骨折的系統評價. 中國組織工程研究, 2012, 16(13): 2384-2388.
7. 陳斌, 徐永清, 李晶, 等. 腕舟骨骨折三維運動學在體實驗研究. 中華手外科雜志, 2009, 25(6): 365-368.
8. 路來金. 亟待提高腕舟骨骨折的整體診治水平. 中華手外科雜志, 2016, 32(2): 81-82.
9. 傅重洋, 丁暉原, 趙巍, 等. 應用注射器針導引掌側經皮 Bold 空心螺釘固定腕舟骨骨折. 中華手外科雜志, 2014, 30(3): 188-190.
10. Taleb C, Bodin F, Collon S, et al. Retrograde percutaneous screw fixation for scaphoid type Ⅱ non-union in Schernberg zones 2 to 4: a series of 38 cases. Chir Main, 2015, 34(1): 32-38.
11. 孫勇偉, 張蜀華. CT 引導下經皮 Herbert 螺釘微創治療腕舟骨骨折 21 例報告. 中國微創外科雜志, 2014, 14(7): 644-646, 657.
12. 林旭, 曾俊, 郭勇, 等. 計算機輔助設計個體化腕舟骨重建: 指導經皮空心釘置入內固定修復. 中國組織工程研究, 2014, 18(44): 7178-7182.
13. Yin HW, Xu J, Xu WD. 3-Dimensional printing-assisted percutaneous fixation for acute scaphoid fracture: 1-shot procedure. J Hand Surg (Am), 2017, 42(4): 301.e1-301.e5.
14. Becciolini M, Bonacchi G. Fracture of the sesamoid bones of the thumb associated with volar plate injury: ultrasound diagnosis. J Ultrasound, 2015, 18(4): 395-398.
15. Zhang GY, Zhuang HY, Wang LX. Value of high frequency ultrasonography in diagnosis and surgical repair of traumatic finger tendon ruptures. Med Princ Pract, 2012, 21(5): 472-475.
16. Mohseny B, Nijhuis TH, Hundepool CA, et al. Ultrasonographic quantification of intrinsic hand muscle cross-sectional area; reliability and validity for predicting muscle strength. Arch Phys Med Rehabil, 2015, 96(5): 845-853.
17. 王孝輝, 沈素紅, 李德, 等. 超聲引導下閉合復位穿針固定治療成人指骨骨折. 中華超聲影像學雜志, 2016, 25(9): 804-807.
18. 王雷, 王孝輝, 李無陰. 超聲與 C 臂 X 線機引導閉合復位穿針固定治療掌指骨骨折的療效比較. 中國修復重建外科雜志, 2017, 31(10): 1179-1183.
19. 王孝輝, 張彩麗, 沈素紅, 等. 超聲引導下手法復位牽引托板固定治療掌骨頸骨折. 中國骨傷, 2018, 31(3): 254-256.
20. 沈素紅, 王孝輝, 付卓. 超聲引導下閉合復位微創固定治療掌指骨骨折. 中國醫學影像技術, 2018, 34(2): 293-296.
21. Anas EM, Seitel A, Rasoulian A, et al. Registration of a statistical model to intraoperative ultrasound for scaphoid screw fixation. Int J Comput Assist Radiol Surg, 2016, 11(6): 957-965.

Chinese Journal of Reparative and Reconstructive Surgery

Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture

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