Treatment of acute non-displaced scaphoid fracture of wrist with syringe needle-guided percutaneous cannulated headless hollow compression screw internal fixation / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of needle-guided percutaneous cannulated compression screw fixation in the treatment of acute non-displaced scaphoid fracture of wrist.@*METHODS@#The clinic data of twenty-eight patients with acute non-displaced scaphoid fracture from January 2014 to January 2019 were analyzed retrospectively. According to the intraoperative method of placement of cannulated screw, they were divided into Guide group(16 patients)and Conventional group(12 patients). There were 13 males and 3 females in Guide group, aged from 20 to 60 years old with an average of(31.42±9.71)years old;5 patients were classified as type A2, 3 patients were classified as type B1 and 8 patients were classified as type B2 according to Herbert classification;they were treated with percutaneous cannulated compression screw fixation under the guidance of needle. There were 11 males and 1 female in Conventional group, aged from 23 to 61 years old with an average of(30.51±7.52)years old;5 patients were classified as type A2, 2 patients were classified as type B1 and 5 patients were classified as type B2 according to Herbert classification;they were treated with conventional percutaneous cannulated compression screw fixation. The operation time, screw angle relative to the longitudinal axis of the scaphoid and wrist function score were assessed and compared between the two groups.@*RESULTS@#A total of 28 patients were followed up from 20 to 45 months with an average of (33.00±8.72) months. None of patients had intraoperative complication and incision infection. These patients returned to work gradually 2 weeks after operation, and all fractures healed within 12 weeks. The operation time in the Guide group was significantly less than that in the Conventinal group(P<0.05). Screw angle relative to the longitudinal axis of the scaphoid in the Guide group was significantly smaller than that in the Conventional group(P<0.05). There was no significant difference in Mayo wrist function scores at the last follow-up between the two groups(P>0.05). During the follow-up period, none of the 28 patients showed internal fixation displacement, arthritis, scaphoid necrosis and other complications.@*CONCLUSION@#In the treatment of acute non-displaced scaphoid fractures, the operation time of needle-guided percutaneous cannulated headless compression screw fixation is significantly shorter than that of conventional percutaneous screw fixation, and the screw axis is easier to be parallel to the longitudinal axis of the scaphoid.

Osteosynthesis of a scaphoid neck fracture with a cannulated compression screw: evaluation of 52 patients / Osteossíntese de fratura no colo do escafoide com parafuso canulado de compressão: avaliação de 52 pacientes

ABSTRACT Objective: To evaluate the effectiveness of the dorsal fixation technique with a cannulated compression screw (CCS) for transverse scaphoid neck fractures. Methods: A case series study was carried out with patients treated with a CSS between April 2014 and May 2021. The main outcome was the healing of the fracture, verified by radiographic evaluation that used images of the wrist in anteroposterior, lateral, radial deviation, ulnar deviation and oblique views, obtained in the postoperative period. Results: Fifty-two patients aged between 15 and 65 years were analyzed, of which 43 (83%) were male. Of the 52 patients, 19 (36.53%) had a right-hand injury and 33 (63.46%) had a left-hand injury. Results were excellent in 47 patients (90.38%); good in 4 patients (7.69%), with reduced mobility compared to contralateral and poor in 1 patient (1.92%), with failure of consolidation and breakage of the synthesis material. In 51 cases (99%) there was bone consolidation at the end of six months. Conclusion: Osteosynthesis with a cannulated compression screw is a safe, effective and promising method for the treatment of scaphoid neck fractures. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar a eficácia da técnica de fixação dorsal com parafuso canulado de compressão (CCS) para fraturas transversas do colo do escafoide. Métodos: Foi realizado um estudo de série de casos com pacientes tratados com CSS entre abril de 2014 e maio de 2021. O desfecho principal foi a consolidação da fratura, verificada por meio da avaliação radiográfica das imagens do punho em anteroposterior, perfil, desvio radial, desvio ulnar e oblíquo obtidas no pós-operatório. Resultados: Foram analisados 52 pacientes com idade entre 15 e 65 anos, sendo 43 (83%) do sexo masculino. Dos 52 pacientes, 19 (36,53%) tinham lesão na mão direita e 33(63,46%) na mão esquerda. Os resultados foram excelentes em 47 dos pacientes (90,38%); bons em quatro (7,69%), com mobilidade reduzida comparada ao membro contralateral; e ruim em um (1,92%), com falha da consolidação e quebra do material de síntese. Em 51 casos (99%) houve consolidação óssea ao final de seis meses. Conclusão: A osteossíntese com parafuso canulado de compressão é um método seguro, eficaz e promissor para o tratamento das fraturas no colo do escafoide. Nível de Evidência IV, Série de Casos.

WALANT Technique in Percutaneous Scaphoid Osteosynthesis / WALANT na osteossíntese percutânea do escafoide

Abstract Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Resumo As fraturas do escafoide representam entre 50 e 70% de todas as fraturas dos ossos do carpo. A osteossíntese percutânea do escafoide pode usar a abordagem dorsal ou volar, ambas com bons resultados. É mais comumente realizada sob anestesia geral ou bloqueio nervoso regional. A técnica de anestesia local com o paciente totalmente acordado e sem torniquete (WALANT, na sigla em inglês) já é considerada uma técnica segura e eficaz na cirurgia da mão. A anestesia local com epinefrina causa vasoconstrição, o que evita o uso de torniquete e, consequentemente, a necessidade de sedação do paciente. Assim, a possibilidade de testar a estabilidade da fixação sob forças fisiológicas é outra grande vantagem do uso da anestesia local. Na técnica descrita aqui, o movimento ativo do punho e da mão pode ser testado imediatamente após a fixação escafoide. A técnica WALANT tem sido cada vez mais utilizada na cirurgia da mão em partes moles e na fixação de fraturas de metacarpo e falanges. No entanto, até o momento, não há literatura publicada abordando o uso dessa técnica na osteossíntese percutânea do escafoide. O objetivo desta nota técnica é descrever o uso de WALANT tanto para a abordagem dorsal quanto volar na osteossíntese percutânea do escafoide.

Percutaneous Grafting and Screw Fixation in Patients with Scaphoid Nonunion / Enxerto percutâneo e fixação de parafusos em pacientes com não consolidação do escafoide

Abstract Objective The aim of the present study was to analyze the clinical and radiological results of patients with type-V cystic scaphoid nonunion who were treated with percutaneous grafting and screw. Methods A total of 11 patients were treated with a percutaneous bone graft with screw fixation. The criteria for inclusion in the study were a type-V scaphoid nonunion and age > 18 years old. Those with humpback deformity, arthritis, ligament damage determined on magnetic resonance imaging, or avascular necrosis (AVN) in the nonunion fragment were excluded from the study. Results The mean follow-up time was 36 months (range: 15-53 months). At the final follow-up examination, the mean visual analogue scale score was 1.06 (range: 0-2.3). Postoperatively, the mean extension was 61.6° (44-80°), flexion 66° (60-80°), radial deviation 12° (7-20°), and ulnar deviation 25° (20-34°). The mean grip strength of the operated hand was found to be 94%, compared with the healthy side. The results obtained in the Mayo Modified Wrist Score were poor in 2 patients, good in 2 and excellent in 7 (64%). With the exception of 2 patients, union was obtained radiologically in 9 patients, with a mean of 12.6 weeks (range, 8-16 weeks). Conclusion Percutaneous grafting and screw fixation cannot replace open surgery in cases with deformity, shortening, humpbacking, or in long term nonunions; however, it is a reliable and effective treatment method in selected cases, such as Slade & Dodds type-V cystic nonunion.

Resumo Objetivo O objetivo do presente estudo foi analisar os resultados clínicos e radiológicos de pacientes com não consolidação do escafoide que foram tratados com enxerto percutâneo e parafuso. Métodos Um total de 11 pacientes foram tratados com enxerto ósseo percutâneo com fixação de parafuso. Os critérios de inclusão no estudo foram não consolidação do escafoide do tipo 5 e idade > 18 anos. Foram excluídos do estudo aqueles com deformidade corcunda, artrite, dano ligamentar determinado por ressonância magné- tica ou necrose avascular (NAV) no fragmento de não consolidação. Resultados O tempo médio de seguimento foi de 36 meses (intervalo: 15-53 meses). No exame final de seguimento, o escore médio de escala visual analógica foi de 1,06 (intervalo: 0-2,3). No pós-operatório, a extensão média foi de 61,6° (44-80°), flexão 66° (60-80°), desvio radial 12° (7--20°) e desvio ulnar 25° (20-34°). A força média de aderência da mão operada foi de 94% em comparação com o lado saudável. Os resultados obtidos no Mayo Modified Wrist Score foram ruins em 2 pacientes, bons em 2 e excelentes em 7 (64%). Com exceção de 2 pacientes, a consolidação foi confirmada radiologicamente em 9 pacientes com média de 12,6 semanas (intervalo: 8-16 semanas). Conclusão Enxerto percutâneoe fixação de parafusos não podem substituir a cirurgia aberta em casos de deformidade, encurtamento ou acorcundamento ou em não consolidação a longo prazo; no entanto, é um método de tratamento confiável e eficaz em casos selecionados, tais como a não consolidação do tipo V de Slade e Dodds.

Treatment of Chondral Knee Lesions with Autologous Chondrocytes Embedded in a Fibrin Scaffold. Clinical and Functional Assessment / Tratamento de lesões condrais no joelho com condrócitos autólogos embebidos em arcabouço de fibrina. Avaliação clínica e funcional

Abstract Objective The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries. Methods We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm2 in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1-6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results. Results Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state (p < 0.05). They were also able to carry out their sporting activities more easily than prior to surgery (p < 0.05). Conclusion The seeding of chondrocytes in fibrin may provide a favorable microenvironment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.

Resumo Objetivo O objetivo do nosso estudo é analisar os resultados clínicos e funcionais do tratamento de lesões nas articulações do joelho com condrócitos autólogos embebidos em arcabouço de fibrina. Métodos O estudo foi realizado com 56 pacientes (36 homens e 20 mulheres) com idade média de 36 anos; 6 indivíduos eram atletas profissionais. Os pacientes apresentavam lesões únicas, condrais ou osteocondrais (43 condrais, nove osteocondrais, 2 casos de osteocondrite dissecante e duas fraturas osteocondrais) no joelho, com 2 a 10 cm2 de tamanho e ≤ 10 mm de profundidade, sem sinais de osteoartrite. As lesões estavam localizadas na patela (8), no côndilo femoral medial (40), no côndilo femoral lateral (7) e na tróclea (1). O período médio de acompanhamento foi de 3 anos (faixa de 1-6 anos). A evolução clínica foi avaliada pelos escores de Cincinnati e Knee Injury and Osteoarthritis Outcome (KOOS), 6 e 12 meses após a cirurgia. O teste t de Student pareado foi utilizado para comparação dos achados pré e pós-operatórios. Resultados Os pacientes retomaram suas atividades diárias 6 meses após o implante. Os escores avaliados demonstraram a melhora em comparação ao estado pré-cirúrgico (p < 0,05). Além disso, os pacientes conseguiram realizar suas atividades esportivas com mais facilidade do que antes da cirurgia (p < 0,05). Conclusão A cultura de condrócitos em fibrina pode proporcionar um microambiente favorável para a síntese de matriz extracelular e melhorar a condição clínica e a atividade dos pacientes 1 ano após a cirurgia

Treatment of fresh undisplaced scaphoid lumbar fractures with robotic navigation and percutaneous internal fixation / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of robotic navigation and percutaneous internal fixation in the treatment of fresh undisplaced scaphoid lumbar fractures.Methods:From November 2019 to October 2020, 8 patients were treated at Department of Hand Surgery, Xuzhou Renci Hospital for fresh undisplaced scaphoid lumbar fractures. There were 7 males and one female with an average age of 27.5 years (from 18 to 42 years), and 5 left and 3 right cases. Navigation by a Tianji orthopedic robot was conducted to decide the positions for implantation of percutaneous Herbert screws to fixate the fractures. The bone healing was followed up by regular X-ray and CT examinations. The functional recovery was evaluated by Mayo wrist score, grip strength, pinch strength and wrist range of motion, and the wrist pain was evaluated by visual analogue scale (VAS).Results:All the 8 patients were followed up for a mean time of 12.8 months (from 6 to 19 months). All the wounds healed by the first intention without any inflammation or infection. CT examination at 3 months postoperation found that all the fracture ends got united. At the final follow-up, the average active motions of the injured wrist were: 67.9° in flexion, 64.1° in extension, 21.2° in radial deviation and 52.2° in unlar deviation, respectively. The average grip strength was recovered to 31.3 kg, reaching up to 85.2% (from 66.7% to 100.0%) of the contralateral wrist; the average pinch force was recovered to 19.5 kg, reaching up to 89.3% (from 77.8% to 100.0%) of the contralateral wrist. At the last follow-up, the Mayo wrist function scores averaged 97.5 (from 95 to 100) and all the 8 cases were excellent. The VAS pain score of the wrist averaged 0.88 (from 0 to 2).Conclusion:In the treatment of fresh undisplaced scaphoid lumbar fractures, navigation with a Tianji orthopedic robot can be used to visualize percutaneous minimally invasive screw fixation so that accurate positioning and precise screw placement are ensured, leading to rapid rehabilitation.

Percutaneous Fixation without Bone Graft for Scaphoid Nonunion / Fixação percutânea sem enxerto ósseo para pseudartrose do escafóide

Abstract Objective To describe the clinical and radiographic outcomes of patients submitted to percutaneous fixation without bone graft for scaphoid nonunion, with a minimum follow-up of six months. Methods A case series study of a convenience sample of hand surgeons with prospective evaluation. Patients with scaphoid (waist or proximal pole) nonunion and the following features were included: more than six months of history; X-rays showing sclerosis of the edges of the nonunion, with resorption of the nonunion focus measuring less than 4 mm (Slade & Gleissler I, II, III and IV) and no angular deformity; and no proximal pole necrosis on magnetic resonance imaging (MRI). Results After six months of follow-up, all nonunion were consolidated, with no major complications. The functional outcomes revealed good scores on the disabilities of the arm, shoulder and hand (DASH; n = 12; mean: 6.9; standard deviation [SD]: 2.1) and patient-rated wrist evaluation (PRWE; n = 12; mean: 7.97, SD: 1.5) questionnaires. The results of the visual analog scale (VAS) showed little residual pain (n = 12; mean: 0.71; SD: 0.2). Slight decreases in flexion (69 versus 59.1; p = 0.007), extension (62.4 versus 48.7; p = 0.001) and radial deviation (29.6 versus 24.6; p = 0.014) were detected in comparison to the contralateral side. Conclusions All cases in the series presented consolidation and good functional scores at the six-month evaluation. This is a promising option (with lower technical demand and morbidity) for the treatment of scaphoid nonunion. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.

Resumo Objetivo Descrever os resultados clínico-radiográficos de pacientes tratados por meio de fixação percutânea sem enxerto ósseo para pseudartrose do escafóide, com seguimento mínimo de seis meses. Métodos Série de casos de uma amostra de conveniência de grupo de cirurgiões de mão com avaliação prospectiva.. Foram incluídos pacientes com diagnóstico de pseudartrose do escafóide (cintura ou polo proximal) com as seguintes características: mais de seis meses de histórico; radiografias demonstrando esclerose das bordas da pseudartrose, com reabsorção do foco de pseudartrose menor do que 4 mm (Slade & Gleissler I, II, III e IV), sem deformidade angular; e sem necrose do polo proximal pela ressonância magnética (RM). Resultados Na avaliação com mais de seis meses, todas as pseudartroses estavam consolidadas e sem maiores complicações. Os resultados funcionais demonstraram boas pontuações nos questionários de disfunções do braço, ombro e mão (disabilities of the arm, shoulder and hand, DASH; n = 12; média: 6,9; desvio padrão [DP]: 2,1) e de avaliação do punho pelo paciente (patient-rated wrist evaluation, PRWE; n = 12; média: 7,97; DP: 1,5). Observou-se pouca dor residual de acordo com a escala visual analógica (EVA; n = 12; média: 0,71; DP: 0,2). Houve discreta diminuição da flexão (69 versus 59,1; p = 0,007), da extensão (62,4 versus 48,7; p = 0,001) e do desvio radial (29,6 versus 24.6; p = 0,014) em comparação ao lado contralateral. Conclusões Nesta série, todos os casos estavam consolidados ao sexto mês de avaliação, com bom status funcional. Trata-se de uma opção promissora (menor demanda técnica e morbidade) para o tratamento da pseudartrose do escafóide. Estudos comparativos serão úteis para avaliar a efetividade da técnica com relação a outras opções.

Fratura fisária do rádio e luxação perilunar do carpo: um relato de caso / Physeal fracture of radius and perilunate dislocation of carpo: a case report

A relevância do relato de caso em questão está em sua raridade de acometimento durante a infância (período em que se observa um sinal clássico em uma das radiografias solicitadas). Trata-se de uma luxação perilunar em punho direito, associada à fratura fisária do rádio em criança de onze anos, após acidente com laço. Foi feita a redução fechada e colocação de tala gessada no membro, o qual também apresentava áreas de sofrimento da pele causadas pela corda. O quadro clínico do paciente evoluiu com dor, edema e diminuição da perfusão. Nesse momento, foi encaminhado para o centro cirúrgico onde foi realizada redução aberta com incisão dorsal em S, fixação da luxa-ção e fasciotomia. Após o ato cirúrgico, paciente evoluiu bem. Atualmente, após algumas sessões de fisioterapia, tem movimento quase total de flexão e extensão do punho, restando apenas limitação no desvio ulnar e radial. As crianças do século XXI se mostram muito ativas em vista disso têm aumentado os casos de fratura e luxação na pediatria, tanto pelo aumento do impacto quanto pela exposição a possíveis mecanismos de lesão. (AU)

The relevance of this case report is its rarity of involvement during childhood (the period in which there is a classic sign in one of the required x-rays). This is a case of perilunate dislocation in right wrist associated with physeal fracture of radius in an eleven-year-old child, after a rope accident. The closed reduction and placement of a plas-ter splint were performed, which also presented areas of skin suffering caused by the rope. The patient's medical condition evolved for pain, edema, and decreased perfusion. At that time, he was transferred to a surgical center where it was performed an open reduction with a dorsal incision in S, dislocation fixation and fasciotomy. After the surgical procedure, the patient's medical condition developed well. Currently, after some physical therapy sessions, he has almost total movement of flexion and extension of his wrist, there is the only limitation in ulnar and radial deviation. Children of the 21st century are very active, and there has been an increase in the cases of fracture and dislocation, in pediatrics, both by increasing impact and exposure to possible mechanisms of injury (AU)

Treatment of schaphoid nonunion with volar locked plate / Tratamento da pseudoartrose do escafoide com placa bloqueada volar

ABSTRACT Objective: To assess and compare radiographic, tomographic and functional pre and postoperative parameters of patients submitted to treatment of nonunion of the scaphoid waist with locked plate for scaphoid. Methods: This is a case series of scaphoid waist nonunion, operated from March 2017 to March 2018 at the Institute of Orthopedics and Traumatology of HCFMUSP, using the technique of Fisk-Fernandez and osteosynthesis with locked plate for scaphoid APTUS®Hand from Medartis. The patients were submitted to radiographs, computed tomography and functional evaluation by the occupational therapy team in the pre and postoperative periods. Results: There was consolidation of the scaphoid waist nonunion in all cases, improvement in the parameters of carpal alignment in the imaging examinations, but functionally we observed reduction of the range of motion and grip strength in relation to the contralateral limb. Conclusions: The treatment of the scaphoid waist nonunion with locked plate was effective, with a high index of consolidation and improvement of the carpal alignment in the imaging tests, although with a reduction in the range of motion and grip strength in relation to the contralateral limb when evaluated with 12 weeks postoperatively. Level of Evidence IV, Case series.

RESUMO Objetivos: Avaliar e comparar parâmetros radiográficos, tomográficos e funcionais pré e pós-operatórios de pacientes submetidos ao tratamento de pseudoartrose do colo do escafoide com placa bloqueada para escafoide. Métodos: Esta é uma série de casos de pseudoartrose do colo do escafoide, operados no período de março de 2017 a março de 2018 no Instituto de Ortopedia e Traumatologia do HCFMUSP, utilizando-se a técnica de Fisk-Fernandez e osteossíntese com placa bloqueada para escafoide APTUS®Hand da Medartis. Os pacientes foram submetidos a radiografias, tomografia computadorizada e avaliação funcional pela equipe de terapia ocupacional no pré e pós-operatório. Resultados: Houve consolidação da pseudoartrose do colo do escafoide em todos os casos e melhora nos parâmetros de alinhamento carpal nos exames de imagem, porém, funcionalmente, observamos redução da amplitude de movimento e força de preensão em relação ao membro contralateral. Conclusão: O tratamento da pseudoartrose do colo do escafoide com placa bloqueada se mostrou efetivo, com elevado índice de consolidação e melhora do alinhamento carpal nos exames de imagem, embora com redução da amplitude de movimento e força de preensão em relação ao membro contralateral, quando avaliados com 12 semanas de pós-operatório. Nível de Evidência IV, Série de casos.

Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone / 中国骨伤

OBJECTIVE@#To explore short-term clinical effects of bone and soft tissue combined with surgery for the treatment of soft flatfoot accompanied with painful navicular bone.@*METHODS@#From May 2015 to August 2017, 16 patients (16 feet) with navicular bone soft flatfoot accompanied with painful navicular bone were treated with bone and soft tissues operation (gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon). Among them, there were 9 males (9 feet) and 7 females (7 feet), aged from 22 to 48 years old with an average of (32.0±3.4) years old. The duration of diseases ranged from 6 months to 5 years with an average of (2.4±1.7) years. The postoperative complications were observed, talocalcaneal angle, the first metatarsal horn of the talus, arch height, angle of inclination and calcaneal valgus before and after operation at 12 months were compared. VAS score and AOFAS score after operation at 12 months were applied to evaluate pain relief and function.@*RESULTS@#All patients were followed up for an average of (18.4±3.5) months(13~25 months). The incisions of patients were healed at grade A without wound infection, nonunion or delayed union, internal fixation fracture or loosening and other complications. Medial pain of foot was disappeared and motor ability was restored at 12 months after operation. Arch height, angle of inclination and the first metatarsal horn of the talus of lateral X-ray before operation and after operation at 12 months on weight-bearing foot were(21.51±1.20)°vs(31.01±1.62)°, (10.71±1.52)°vs(22.12±2.11)°, (15.61±1.41)°vs(5.10±1.20)°; talocalcaneal angle, the first metatarsal horn of the talus of AP X-ray before operation and after operation at 12 months on weight-bearing foot were (36.12±2.21) ° vs (22.12±2.61)°, (13.41±1.51)°vs(4.30±0.91)°; calcaneal valgus of axial X-ray before operation and after operation at 12 months on weight-bearing foot were (10.80±1.21)°vs(3.92±1.81)°; there were statistical difference in imaging indicators between preoperation and 12 months after operation. VAS score was significantly decreased from (6.21±2.31) before operation to (1.82±0.56) at 12 months after operation (=2.64, <0.05). AOFAS score was obviously increased from (51.2±5.6)before operation to (87.1±4.7)at 12 months after operation (=3.43, <0.05).@*CONCLUSIONS@#Bone and soft tissue operation (namely, gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon) could obviously relieve foot pain, improve foot appearance and function in patients with navicular bone soft flatfoot complicated with painful navicular bone, and has certain clinical efficacy.

Arthroscopic bone grafting with percutaneous fixation in treating scaphoid nonunion / 中华骨科杂志

Objective@#To analyze the clinical effects of arthroscopic autologous bone grafting and percutaneous fixation in treating scaphoid nonunion.@*Methods@#From May 2013 to August 2017, a total of 25 cases of patients including 20 males and 5 females with unilateral scaphoid fractures and nonunion were reviewed, with mean age of 35.80±2.41 years (18-65 years). The duration from injury to treatment was averaged 11.70±1.90 months (5-18 months). All of the cases sustained waist and proximal end fractures. X-ray and CT scan showed sclerosis and bone resorption without any callus at the fracture sites. However, there were no serious deformities and wrist arthritis. The patients suffered pain and weakness at the radial side of the wrist. The type of the fractures were Slade-Geissler's III-VI, including grade III 4 cases, grade IV 13 cases, grade V 7 cases and grade VI 1 case. The patients were treated with arthroscopic debridement of the sclerotic bone, autologous bone grafting, percutaneous screw (9 cases) or K-wires fixation (16 cases) and immobilization by plaster for 3 weeks after operation, followed by functional rehabilitation training. Bone union was assessed by serial plain radiographs and CT scan regularly. The functional effects were evaluated by comparing the modified Mayo wrist score with the visual analogue scale (VAS) for pain, range of motion (ROM) and the grip strength, which were measured before operation and at 18 months after operation.@*Results@#All cases were followed up. Bone union was achieved in all of 25 nonunion. The average radiological union duration was 10.24±2.10 weeks (6-20 weeks). The average VAS score decreased from 6.75±1.10 preoperatively to 1.33±0.21. The mean ROM of wrist was improved to 168.48°±12.41° (92.90% of that of the normal side), compared to that of 135.24°±17.47° preoperatively (79.80% of that of the normal side). The mean grip strength showed improvement from an average of 35.68±3.81 kg (80.46% of that of normal side) preoperatively to 48.75±4.42 kg (90.65% of that of normal side). The average modified Mayo wrist score improved from 61.52±6.32 preoperatively to 85.88±8.37.@*Conclusion@#Arthroscopic autologous bone grafting with percutaneous cannulated screw and K-wires fixation is an effective and minimally invasive treatment for scaphoid nonunion, which could protect the blood supply of the fracture sites, decrease the surgical complications, promote bone healing and lead to a faster recovery.

The efficacy of derotation of talus and medial column fusion for Müller-Weiss disease / 中华骨科杂志

Objective@#To explore the mid-term efficacy of derotation of talus and medial column fusion for stage II-V Müller-Weiss disease (MWD).@*Methods@#Data of thirty-six patients (38 feet) with MWD treated by derotation of talus and talona-vicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center during January 2008 to December 2016 were retrospective-ly analyzed. There were 3 males (3 feet) and 33 females (35 feet) with an average age of 54.0±9.2 years old (range, 32-80 years old); there were 11 right feet and 27 left feet. According to Maceira and Rochera staging system, there were 9 stage II cases, 11 stage III cases, 10 stage IV cases and 8 stage V cases. The external rotation of talus was intensively focused. After the TN articular surface was debrided, an "H" shape plate and a hollow lag screw were used to firmly fix the TN or TNC joint. American Orthopae-dic Foot and Ankle Society Scale (AOFAS), visual analog scale (VAS) and relative radiological parameters were evaluated preoper-atively and during follow-up.@*Results@#The mean follow-up duration was 37.2 months (range, 25-113 months). The latest follow-up showed satisfactory outcomes. Overall, AOFAS score was improved from 41.3±11.3 points (range, 20-56 points) preoperatively to 85.5±7.1 points (range, 68-100 points) postoperatively (Z=5.16, P< 0.001), and the VAS score was reduced from 5.6±1.5 points (range, 3-8 points) preoperatively to 0.8±1.2 points (range, 0-4 points) postoperatively (Z=5.19, P< 0.001). These differences of functional score and pain evaluation were statistically significant. The Tomeno-Méary angle decreased from-6.6°±12.2° to 0.5°±2.9° (Z=3.43, P=0.001); the calcaneal pitch angle increased from 13.5°±3.9° to 22.1°±3.4°(t=10.12, P< 0.001), and the talarnavic-ular coverage angle decreased from 27.1°±5.9° to 7.6°±3.3°(Z=5.16, P< 0.001). The AP talar-first metatarsal angle decreased from-16.0°±10.7° to-7.0°±8.5°(t=5.49, P< 0.001). The differences of radiological parameters were statistically significant.@*Conclusion@#The mid-term results showed that the TN or TNC joint fusion could achieve a favorable clinical and radiological outcome for MWD patients. Even for the patients with severe deformities (stage II-V), such treatment strategy could also achieve satisfacto-ry deformity correction and functional improvement. Intraoperative restoration of talus rotation is the key to normal alignment of the subtalar joint/TN joint.

The efficacy of derotation of talus and medial column fusion for Müller-Weiss disease / 中华骨科杂志

Objective To explore the mid-term efficacy of derotation of talus and medial column fusion for stage Ⅱ-Ⅴ Müller-Weiss disease (MWD).Methods Data of thirty-six patients (38 feet) with MWD treated by derotation of talus and talonavicular (tTN) or talonavicular-cuneiform (TNC) arthrodesis in our center during January 2008 to December 2016 were retrospectively analyzed.There were 3 males (3 feet) and 33 females (35 feet) with an average age of 54.0±9.2 years old (range,32-80 years old);there were 11 right feet and 27 left feet.According to Maceira and Rochera staging system,there were 9 stage Ⅱ cases,11 stage Ⅲ cases,10 stage Ⅳ cases and 8 stage Ⅴ cases.The external rotation of talus was intensively focused.After the TN articular surface was debrided,an "H" shape plate and a hollow lag screw were used to firmly fix the TN or TNC joint.American Orthopaedic Foot and Ankle Society Scale (AOFAS),visual analog scale (VAS) and relative radiological parameters were evaluated preoperatively and during follow-up.Results The mean follow-up duration was 37.2 months (range,25-113 months).The latest follow-up showed satisfactory outcomes.Overall,AOFAS score was improved from 41.3± 11.3 points (range,20-56 points) preoperatively to 85.5±7.1 points (range,68-100 points) postoperatively (Z=5.16,P＜ 0.001),and the VAS score was reduced from 5.6±1.5 points (range,3-8 points) preoperatively to 0.8± 1.2 points (range,0-4 points) postoperatively (Z=5.19,P＜ 0.001).These differences of functional score and pain evaluation were statistically significant.The Tomeno-Méary angle decreased from-6.6°± 12.2° to 0.5°± 2.9° (Z=3.43,P=0.001);the calcaneal pitch angle increased from 13.5°±3.9° to 22.1 °±3.4°(t=10.12,P＜ 0.001),and the talarnavicular coverage angle decreased from 27.1°±5.9° to 7.6°±3.3°(Z=5.16,P＜ 0.001).The AP talar-first metatarsal angle decreased from-16.0°±10.7° to-7.0°±8.5°(t=5.49,P＜ 0.001).The differences of radiological parameters were statistically significant.Conclusion The mid-term results showed that the TN or TNC joint fusion could achieve a favorable clinical and radiological outcome for MWD patients.Even for the patients with severe deformities (stage Ⅱ-Ⅴ),such treatment strategy could also achieve satisfactory deformity correction and functional improvement.Intraoperative restoration of talus rotation is the key to normal alignment of the subtalar joint / TN joint.

Efficacy evaluation of dry arthroscopy technique in wrist arthroscopy for wrist joint injury / 中华创伤杂志

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures ( including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion) , 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months ( average 9 months) . All the old scaphoid fractures were healed, with the average healing time of 12. 6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time.

Arthroscopic bone grafting with percutaneous fixation in treating scaphoid nonunion / 中华骨科杂志

Objective To analyze the clinical effects of arthroscopic autologous bone grafting and percutaneous fixation in treating scaphoid nonunion.Methods From May 2013 to August 2017,a total of 25 cases of patients including 20 males and 5 females with unilateral scaphoid fractures and nonunion were reviewed,with mean age of 35.80±2.41 years (18-65 years).The duration from injury to treatment was averaged 11.70± 1.90 months (5-18 months).All of the cases sustained waist and proximal end fractures.X-ray and CT scan showed sclerosis and bone resorption without any callus at the fracture sites.However,there were no serious deformities and wrist arthritis.The patients suffered pain and weakness at the radial side of the wrist.The type of the fractures were Slade-Geissler's Ⅲ-Ⅵ,including grade Ⅲ 4 cases,grade Ⅳ 13 cases,grade Ⅴ 7 cases and grade Ⅵ 1 case.The patients were treated with arthroscopic debridement of the sclerotic bone,autologous bone grafting,percutaneous screw (9 cases) or K-wires fixation (16 cases) and immobilization by plaster for 3 weeks after operation,followed by functional rehabilitation training.Bone union was assessed by serial plain radiographs and CT scan regularly.The functional effects were evaluated by comparing the modified Mayo wrist score with the visual analogue scale (VAS) for pain,range of motion (ROM) and the grip strength,which were measured before operation and at 18 months after operation.Results All cases were followed up.Bone union was achieved in all of 25 nonunion.The average radiological union duration was 10.24±2.10 weeks (6-20 weeks).The average VAS score decreased from 6.75± 1.10 preoperatively to 1.33±0.21.The mean ROM of wrist was improved to 168.48°± 12.41 ° (92.90％ of that of the normal side),compared to that of 135.24°± 17.47° preoperatively (79.80％ of that of the normal side).The mean grip strength showed improvement from an average of 35.68±3.81 kg (80.46％ of that of normal side) preoperatively to 48.75±4.42 kg (90.65％ of that of normal side).The average modified Mayo wrist score improved from 61.52±6.32 preoperatively to 85.88±8.37.Conclusion Arthroscopic autologous bone grafting with percutaneous cannulated screw and K-wires fixation is an effective and minimally invasive treatment for seaphoid nonunion,which could protect the blood supply of the fracture sites,decrease the surgical complications,promote bone healing and lead to a faster recovery.

How scaphoid fractures are treated in brazil / Como são tratadas as fraturas do escafoide no brasil

ABSTRACT Objective: To verify how hand surgeons manage scaphoid fractures and their complications. Methods: Two hundred questionnaires were distributed during the 36th Brazilian Hand Surgery Congress (2016). Results: On suspicion of fracture without radiographic confirmation, 57% of surgeons request a CT or MRI scan, while 43% opt for immobilization and consecutive radiographs. In stable fractures the preference was for treatment with plaster cast. In fractures with no scaphoid waist displacement, 33% opt for percutaneous fixation. In displaced waist or proximal pole fractures, 66% and 99.4%, respectively, opted for surgical treatment. Most surgeons treat waist nonunion with a nonvascularized bone graft. When absorption at the site of nonunion is greater than 4 mm, 50% prefer to use iliac graft and screw fixation. In proximal pole nonunion, the Zaidemberg technique is preferred by 64%. More experienced surgeons are more likely to request tests in occult fractures (63.9% versus 47.6%; p=0.04), and tend to recommend surgery for distal third fractures more frequently (16.4% versus 4.7%; p=0.02). Conclusions: We have provided an overview of treatment preferences for scaphoid fractures. It should be noted that more experienced surgeons are more likely to request additional tests for occult fractures and to recommend surgical treatment of distal third fractures. Level of Evidence IV, Cross-sectional survey.

RESUMO Objetivo: Verificar como os cirurgiões da mão conduzem o tratamento da fratura de escafoide e suas complicações. Métodos: Durante o 36° Congresso Brasileiro de Cirurgia da Mão (2016) foram distribuídos 200 questionários. Resultados: Na suspeita da fratura sem confirmação radiográfica, 57% dos cirurgiões solicitam TC ou RM, enquanto 43% optam por imobilização e radiografia seriada. Nas fraturas estáveis, a preferência foi tratamento com gesso. Nas fraturas sem desvio da cintura do escafoide, 33% optam pela fixação percutânea. Nas fraturas desviadas do polo proximal ou da cintura, a opção é o tratamento cirúrgico em 66% e 99,4%. A maioria trata a pseudoartrose da cintura com enxerto não vascularizado. Quando a absorção no foco da pseudoartrose é maior que 4 mm, 50% preferem utilizar enxerto do ilíaco e fixar com parafuso. Nas pseudoartroses do polo proximal, a técnica de Zaidemberg é a preferida por 64%. Os cirurgiões mais experientes têm maior propensão para pedir exames em fraturas ocultas (63,9% versus 47,6%; p = 0,04) e tendem a indicar cirurgia com mais frequência para as fraturas do terço distal (16,4% versus 4,7%; p = 0,02). Conclusões: Forneceu-se panorama das preferências de tratamento para as fraturas do escafoide. Destaca-se maior tendência de cirurgiões mais experientes para solicitação de exames subsidiários para fraturas ocultas e maior indicação cirúrgica para as fraturas do terço distal. Nível de Evidência IV, Estudo transversal tipo survey.

APSI scaphoid hemiarthroplasty - long-term results / Hemiartroplastia do escafoide com APSI - resultados funcionais em longo prazo

ABSTRACT Objective: This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. Methods: Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5-8 years). All patients were male, with a mean age of 39 years (range: 28-55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). Results: No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50-80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3-47.7). Conclusion: The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

RESUMO Objetivo: Avaliar os resultados em longo prazo da hemiartroplastia do escafoide proximal no tratamento da osteonecrose avascular pós-traumática na instituição. Métodos: Foram identificados 12 pacientes submetidos a esse procedimento. O tempo médio de seguimento foi de 6,5 anos (entre cinco e oito). Todos os pacientes eram do sexo masculino, com média de 39 anos (entre 28 e 55). Em oito pacientes o membro afetado foi o não dominante. O procedimento foi feito por meio de uma abordagem dorsal e todos os pacientes foram submetidos ao mesmo protocolo de reabilitação. Todos os casos foram avaliados quanto à ocorrência de complicações, dor, amplitude de movimento, capacidade funcional (Mayo Wrist Score) e incapacidade (QuickDASH Score). Resultados: Não foram observadas complicações no período pós-operatório imediato, como infeção ou luxação do implante. No fim do período de seguimento, todos os casos apresentavam osteólise peri-implante no estudo radiográfico. Nenhum dos pacientes abandonou a sua atividade profissional prévia à cirurgia, embora em cerca de 50% dos casos tenha sido necessário algum tipo de adaptação no local de trabalho. A capacidade funcional média foi, de acordo com o Mayo Wrist Score, de 67,5 pontos (entre 50 e 80), correspondeu a um nível de função satisfatório. O escore de incapacidade QuickDASH apresentou uma pontuação média de 25 (entre 3 e 47,7). Conclusão: Os resultados desta série encontram-se em linha com os estudos publicados sobre essa técnica. A hemiartroplastia do escafoide com implante de pirocarbono é uma técnica segura para o tratamento da necrose avascular do polo proximal do escafoide após fratura. Essa técnica permitiu obter um resultado funcional satisfatório após uma média de 6,5 anos de seguimento.

Percutaneous treatment for waist and proximal pole scaphoid fractures / Tratamento percutâneo para fraturas do terço médio e proximal do escafoide

ABSTRACT Objective: Analyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result. Methods: A retrospective cross-cohort study conducted from January 2005 to April 2015, aiming at the consolidation time, epidemiological profile, level of function, return to work, and complications. Results: Twenty-eight patients were selected, with a mean of eight weeks of follow-up. They presented a mean age of 30.5 years, male prevalence (25 patients; 89.2%), and no differences between dominant and non-dominant sides. The mean time from diagnosis was 4.16 weeks, but in three cases of fibrous union, the pre-operative period was over one year. The most frequent mechanism of injury was a fall on the outstretched hand, in 22 cases (78.5%). Of all fractures, 24 cases were in the waist (85.8%) and four were of the proximal pole (14.2%); seven patients had displacement (25%). There was consolidation in 26 cases (92.8%) with a mean of 7.5 weeks after surgery. In cases of non-union, radiological follow-up was up to 24 weeks, requiring a new surgical intervention. Conclusions: Percutaneous fixation is an excellent, reproducible technique that allows early active mobility of the wrist with a low complication rate, although it requires a learning curve.

RESUMO Objetivo: Analisar a técnica de fixação percutânea das fraturas do escafoide em seu terço médio e terço proximal e demonstrar seu resultado Métodos: Estudo retrospectivo de coorte transversal, feito de janeiro de 2005 a abril de 2015, com vistas ao tempo de consolidação, perfil epidemiológico, grau de função, retorno às atividades laborais e complicações. Resultados: Foram selecionados 28 pacientes, com seguimento médio de oito semanas. Este estudo evidenciou uma idade média de 30,5 anos, prevalência do sexo masculino em 25 pacientes (89,2%) e ausência de lado dominante. O tempo médio de diagnóstico foi de 4,16 semanas, porém três casos de união fibrosa apresentaram período pré-operatório superior a um ano. O mecanismo de trauma mais frequente foi a queda sobre o punho em 22 casos (78,5%). Das fraturas, 24 casos foram do terço médio (85,8%) e quatro casos do polo proximal (14,2%), sete casos apresentavam desvio (25%). Houve consolidação de 26 casos (92,8%) com tempo médio de 7,5 semanas de pós-operatório. Nos casos de não consolidação radiológica, o seguimento foi de até 24 semanas, foi necessária uma nova intervenção cirúrgica. Conclusões: A fixação percutânea é uma ótima maneira de tratar esse tipo de fratura, reprodutível, permite a mobilidade ativa precoce do punho com baixo índice de complicações, embora exija curva de aprendizagem.

Application of wrist arthroscopy in treating scaphoid nonunion advanced collapse / 中华创伤杂志

Objective To investigate the clinical effect of wrist arthroscopy in the treatment of scaphoid nonunion advanced collapse (SNAC).Methods A retrospective case series study was performed on the clinical data of 15 SNAC patients admitted from March 2011 to January 2016.There were 12 males and three females,with a mean age of 32 years (range,26-43 years).There were nine cases of right wrist injury and six cases of left wrist injury.The injury duration was 14-72 months,with an average of 18 months.According to the evaluation of the extent of wrist joint inflammation involvement under wrist arthroscopy,there were nine cases at SNAC Ⅰ stage,four at stage Ⅱ,and two at stage Ⅲ.Stage Ⅰ patients underwent wrist arthroscopy assisted radius styloid process resection,scaphoid sclerosis bone removal,and iliac bone grafting and internal fixation.Stage Ⅱ and Ⅲ patients underwent wrist arthroscopy assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone.Joint healing time in the first month of fracture and fusion,visual analogue score (VAS) before operation and at the last follow up,joint mobility,and grip strength were recorded.Wrist function was evaluated by modified Mayo wrist function score at the last follow up.Results The patients were followed up for 9-23 months,with an average of 14 months.All cases were seen primary bone healing.The mean time of fracture healing was 11.7 weeks in stage Ⅰ SNAC patients and the mean healing time was 11 weeks in stage Ⅱ and Ⅲ patients in the first month of joint fusion.VAS decreased from (5.9 ± 0.8) points to (1.6 ± 0.9) points.Range of motion of the wrist including the flexion/extension arc and the radial/ulnar deviation arc increased respectively from preoperative (38.7 ± 6.3) °,(28.6 ± 11.2) °,(19.8 ± 1.4) °and (22.7±5.7) ° to postoperative (54.1 ±5.8)°,(43.3±9.3)°,(22.0±1.9) ° and (30.3± 4.3) °.Grip strength was improved from preoperative (10.7 ± 2.4) kg to postoperative (15.0 ± 1.9) kg (all P ＜ 0.05).The modified Mayo wrist score was increased from preoperative (57.9 ± 7.3) points to postoperative (84.5 ± 6.9) points (P ＜ 0.05).According to modified Mayo wrist scores,the result was excellent in one case,good in nine cases and fair in five.Conclusions For patients with SNAC,it is necessary to evaluate the staging under wrist arthroscopy.Arthroscopy assisted scaphoid bone grafting can be applied to stage Ⅰ patients.For stage Ⅱ and Ⅲ patients,wrist arthroscopy-assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone is helpful to facilitate bone healing,relieve pain,and improve function.

Wrist arthroscopy-assisted percutaneous Kirschner wire fixation for fresh scaphoid fractures / 中华创伤杂志

Objective To compare the efficacy of percutaneous Kirschner wire fixation assisted by wrist arthroscopy and percutaneous hollow screw fixation under fluoroscopy in the treatment of scaphoid fresh fractures.Methods A retrospective case control study was conducted on the clinical data of 34 patients with scaphoid fresh fractures admitted from April 2009 to January 2016,including 23 males and 11 females,aged 21-44 years,with an average of 28.9 years.There were 21 cases on the right side and 13 cases on the left side.According to the classification of Herbert scaphoid fractures,there were 25 cases of type B2 and nine cases of type B3.The duration from injury to operation was 1-13 d,with an average of 3.2 d.According to the different surgical methods,the patients were divided into arthroscopic assisted percutaneous Kirschner wire fixation group (Group A,16 cases) and percutaneous hollow screw fixation under fluoroscopy group (Group B,18 cases).In Group A,four cases were treated with autogenous iliac bone graft,and three cases with scapholunate ligament injury were treated with fixation of scaphoid joint with stage Ⅰ Kirschner wire.The operation time,hospitalization time,bone healing time,visual analogue scale (VAS),disabilities of arm,shoulder and hand score (DASH),modified Mayo wrist function score,and complications were compared between the two groups.Results The patients were followed up for 6-12 months,averaging 7.5 months.The operation time of Group A and Group B was (52.3 ± 11.2) minutes and (42.5 ± 9.7) minutes,respectively (P ＜ 0.01),hospitalization time was (3.9 ± 1.4) d and (4.1 ± 1.5) d respectively (P ＞ 0.05),bone healing time was (11.8 ± 1.4) weeks and (13.2 ± 2.4) weeks respectively (P ＜ 0.05),VAS was (1.1 ± 0.6) points and (1.8 ± 0.7) points respectively (P ＜ 0.05),DASH score was (14.1 ± 5.3) points and (17.2 ± 7.8) points respectively (P ＞ 0.05),and modified Mayo wrist score was (92.1 ± 6.6) points and (85.4 ± 7.5) points respectively (P ＜0.05).One case of early Kirschner wire loosening occurred in Group A,and one case of nonunion and another of residual scapholunate instability were found in Group B.Conclusion For fresh scaphoid fractures with displacement,percutaneous Kirschner wire fixation assisted by wrist arthroscopy can shorten operation time,promote fracture healing,relieve pain,and improve wrist joint function compared with percutaneous hollow screw fixation under fluoroscopy.