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.	蒋继乐, 刘波, 陈山林, 等. 掌、背侧入路经皮加压螺钉内固定治疗急性舟骨腰部骨折. 中华骨科杂志, 2016, 36(14): 898-905.
3.	曾俊, 林旭, 钟泽莅, 等. 个体化经皮空心螺钉内固定治疗 Herbert Ⅰb 型腕舟骨骨折的临床研究. 中国修复重建外科杂志, 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.	蒋协远, 王大伟. 骨科临床疗效评价标准. 北京: 人民卫生出版社, 2005: 33-34.
6.	刘伟, 赵劲民, 苏伟, 等. 经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折的系统评价. 中国组织工程研究, 2012, 16(13): 2384-2388.
7.	陈斌, 徐永清, 李晶, 等. 腕舟骨骨折三维运动学在体实验研究. 中华手外科杂志, 2009, 25(6): 365-368.
8.	路来金. 亟待提高腕舟骨骨折的整体诊治水平. 中华手外科杂志, 2016, 32(2): 81-82.
9.	傅重洋, 丁晖原, 赵巍, 等. 应用注射器针导引掌侧经皮 Bold 空心螺钉固定腕舟骨骨折. 中华手外科杂志, 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.	孙勇伟, 张蜀华. CT 引导下经皮 Herbert 螺钉微创治疗腕舟骨骨折 21 例报告. 中国微创外科杂志, 2014, 14(7): 644-646, 657.
12.	林旭, 曾俊, 郭勇, 等. 计算机辅助设计个体化腕舟骨重建: 指导经皮空心钉置入内固定修复. 中国组织工程研究, 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.	王孝辉, 沈素红, 李德, 等. 超声引导下闭合复位穿针固定治疗成人指骨骨折. 中华超声影像学杂志, 2016, 25(9): 804-807.
18.	王雷, 王孝辉, 李无阴. 超声与 C 臂 X 线机引导闭合复位穿针固定治疗掌指骨骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(10): 1179-1183.
19.	王孝辉, 张彩丽, 沈素红, 等. 超声引导下手法复位牵引托板固定治疗掌骨颈骨折. 中国骨伤, 2018, 31(3): 254-256.
20.	沈素红, 王孝辉, 付卓. 超声引导下闭合复位微创固定治疗掌指骨骨折. 中国医学影像技术, 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. 蒋继乐, 刘波, 陈山林, 等. 掌、背侧入路经皮加压螺钉内固定治疗急性舟骨腰部骨折. 中华骨科杂志, 2016, 36(14): 898-905.
3. 曾俊, 林旭, 钟泽莅, 等. 个体化经皮空心螺钉内固定治疗 Herbert Ⅰb 型腕舟骨骨折的临床研究. 中国修复重建外科杂志, 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. 蒋协远, 王大伟. 骨科临床疗效评价标准. 北京: 人民卫生出版社, 2005: 33-34.
6. 刘伟, 赵劲民, 苏伟, 等. 经皮螺钉置入固定与石膏固定治疗急性无移位性腕舟骨骨折的系统评价. 中国组织工程研究, 2012, 16(13): 2384-2388.
7. 陈斌, 徐永清, 李晶, 等. 腕舟骨骨折三维运动学在体实验研究. 中华手外科杂志, 2009, 25(6): 365-368.
8. 路来金. 亟待提高腕舟骨骨折的整体诊治水平. 中华手外科杂志, 2016, 32(2): 81-82.
9. 傅重洋, 丁晖原, 赵巍, 等. 应用注射器针导引掌侧经皮 Bold 空心螺钉固定腕舟骨骨折. 中华手外科杂志, 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. 孙勇伟, 张蜀华. CT 引导下经皮 Herbert 螺钉微创治疗腕舟骨骨折 21 例报告. 中国微创外科杂志, 2014, 14(7): 644-646, 657.
12. 林旭, 曾俊, 郭勇, 等. 计算机辅助设计个体化腕舟骨重建: 指导经皮空心钉置入内固定修复. 中国组织工程研究, 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. 王孝辉, 沈素红, 李德, 等. 超声引导下闭合复位穿针固定治疗成人指骨骨折. 中华超声影像学杂志, 2016, 25(9): 804-807.
18. 王雷, 王孝辉, 李无阴. 超声与 C 臂 X 线机引导闭合复位穿针固定治疗掌指骨骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(10): 1179-1183.
19. 王孝辉, 张彩丽, 沈素红, 等. 超声引导下手法复位牵引托板固定治疗掌骨颈骨折. 中国骨伤, 2018, 31(3): 254-256.
20. 沈素红, 王孝辉, 付卓. 超声引导下闭合复位微创固定治疗掌指骨骨折. 中国医学影像技术, 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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