Comparison of Two Different Percutaneous Screw Fixations for Treating Herbert B2-Type Acute Scaphoid Fractures

Abstract

Objective: Scaphoid fracture was the most common carpal fracture and the most challenging. The purpose of this study was to investigate and compare the clinical effects of closed reduction and percutaneous cannulated screw internal fixation under fluoroscopy and arthroscopy-assisted percutaneous cannulated screw internal fixation in the treatment of Herbert B2-type of acute scaphoid fractures.

Methods: A retrospective controlled study was conducted on 29 patients with Herbert B2-type acute scaphoid fracture with a displacement of >1 mm admitted to our hospital from January 2017 to June 2021. Patients were divided into two groups, 11 patients were treated with closed reduction percutaneous cannulated screw internal fixation under fluoroscopy and 18 patients were treated with percutaneous cannulated screw internal fixation assisted by arthroscopy. The operative time, intraoperative fluoroscopy times, fracture healing time, complications, and postoperative wrist function score of the two groups were compared.

Results: All patients were followed up for 6-18 months (mean follow-up duration: 10.38 ± 2.69 months). The respective operation times in the arthroscopy group and fluoroscopy group was 51.50 ± 6.69 min and 56.73 ± 11.48 min, respectively (p > 0.05). The number of fluoroscopies performed in the arthroscopy group was (6.83 ± 1.30), which was less than that in the fluoroscopy group (10.91 ± 2.62) (p < 0.05). All fractures in the arthroscopy group healed after the operation, and the fracture healing time was 11.44 ± 1.25W. Ten patients in the fluoroscopy group healed. The fracture healing time was 13.60 ± 2.32 W. The fracture healing time in arthroscopy group was less than that in the fluoroscopy group (p < 0.05). One patient in the fluoroscopy group had nonunion and healed after bone grafting and internal fixation. At the postoperative 6-month follow-up, the modified Mayo wrist function score was used to evaluate the clinical results. The wrist function score of patients in the arthroscopy group was 90 (85, 95), which was >80 (80, 90) in the fluoroscopy group (z = 2.74, p < 0.05).

Conclusion: For Herbert B2-type acute scaphoid fracture with fracture displacement > 1 mm, the arthroscopy-assisted percutaneous cannulated screw internal fixation has less fluoroscopy times, short fracture healing time, and good recovery effect of wrist function compared to the fluoroscopy.

Keywords: bone; carpal arthroscopy; percutaneous screw internal fixation; scaphoid fracture; scaphoid nonunion.

Fig. 1

Operative procedure: Closed reduction and percutaneous cannulated screw internal fixation under fluoroscopy; Arthroscopy‐assisted percutaneous cannulated screw internal fixation

Fig. 2

Medical imaging for case 1: A 24‐year‐old male with right wrist pain, swelling, and limited activity for 1 week due to a car accident. (A, B) Preoperative CT showed that the right Herbert B2‐type carpal scaphoid fracture and the separation and displacement of the broken end were 1.77 mm; (C) Closed reduction and temporary guide wire fixation; (D, E) Intraoperative C‐arm fluoroscopy showed that the fracture and guide pin were in good position; (F, G) After screwing in the screw and pulling out the guide pin, C‐arm fluoroscopy showed that the fracture and screw position were good; (H, I) Radiography showed that the fracture line disappeared 12 months after operation; (J, K) 12 months after the operation, the wrist extension and flexion activities were good

Fig. 3

Medical imaging for case 2: A 29‐year‐old male with pain, swelling, and limited activity of the right wrist for 1 day caused by falling from a height. (A) Preoperative CT indicated right carpal scaphoid Herbert B2‐type fracture; (B, C) Preoperative CT and three‐dimensional reconstruction showed that the displacement of carpal scaphoid fracture was obvious, and the fracture step reached 4.08 mm; (D) fracture reduction with arthroscopically assisted procedure; (E, F, G) The screw was inserted along the guide wire, and the fracture and internal fixation were in good position under C‐arm fluoroscopy; (H, I) X‐ray image showed that the fracture line disappeared 15 months after the operation; (J, K) The patient had good wrist extension and flexion at 15 months postoperatively