CT-guided Percutaneous Minimally Invasive Treatment by Using Herbert Screws for Wrist Scaphoid Fracture:Report of 21 Cases / 中国微创外科杂志

ABSTRACT

Objective To investigate therapeutic effects of CT-guided percutaneous minimally invasive treatment by using Herbert screws for wrist scaphoid fracture . Methods From September 2010 to October 2012, 21 patients with scaphoid fracture were treated by internal fixation by using Herbert screws under the guidance of CT .The results of the procedure were assessed in terms of osseous union , pain extent , grip strength , and active motion of the wrist .Postoperative outcomes were evaluated by wrist standard scores based on patients’ perception of functions. Results The operation time was 25 -55 min (mean, 35.3 min).The intraoperative blood loss was 8-40 ml (mean, 18.6 ml).Fracture fragments were cured with bone union , with an average healing time of 10.4 weeks (range, 8-17 weeks).All the 21 cases were followed up for 8 -13 months (mean, 9.8 months).The VAS scores at the last follow-up was (1.2 ±0.8) points, which was significantly lower than that before the operation (5.3 ±1.4) points (t=11.785, P=0.000).The grip strength was (39.6 ±3.5) kg, which was significantly higher than that preoperatively [(19.4 ± 2.4) kg, t=-21.624, P =0.000].The Angle of wrist flexion and extension was 115.2°±7.4°, significantly higher than preoperative measure (89.8°±10.4°, t =-9.103, P =0.000).The wrist ulnar radial deflection angle was 53.7°±5.5°, significantly higher than preoperative one (39.4°±3.4°, t =-10.116, P=0.000).At the last follow-up assessment of wrist functions, excellent result was recorded in 18 cases, and good in 3 cases, with a good-or-excellent rate of 100%. Conclusion Treatment of scaphoid fracture with Herbert screws under the guidance of CT is a minimally invasive method , bearing advantages of little incision, simple operation performance , and good effects .