ObjectiveTo 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.
MethodsBetween 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.
ResultsPrimary 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).
ConclusionIndividual 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.
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.
Objective To review the advances in diagnosis and treatment of acute scaphoid fractures. Methods The characteristic, classification, diagnosis, and treatment of acute scaphoid fractures were reviewed and summarized. Results As one of the common fracture in hand, scaphoid fractures are generally classified as either undisplaced and stable or displaced and unstable. CT and MRI has best diagnostic specificity and sensitivity respectively. Most undisplaced and stable fractures can be treated successfully by plaster immobilization, whereas the displaced and unstable fractures have great prognosis after open reduction and internal fixation. Conclusion Acute scaphoid fractures should be diagnosed and treated at an early stage, and choose the appropriate treatment according to the location and stability of the fracture.
Since October 1984, we have designed a method of conversed transplant of radial styloid bone flap with fascial pedicle in the treatment of 22 patients with non-united waist fractures of carpal scaphoid. The results from follow-up of 2-7 years were satisfactory.This article introduced the design of the bone flap, the operative procedure and the advantages of the bone flap.
