Efficacy Of Hollow Screw In The Treatment Of Scaphoid Fracture

Objective: To explore the efficacy of our hospital hollow screw treatment of carpal scaphoid fracture analysis.Methods: Select 70 patients from January 2005 to December 2012 application cannulated screws treatment of carpal scaphoid fractures. Scaphoid fracture according to Herbert classification, Type A2 fracture of 15 patients, type B1 fracture of 19 patients,type B2 fracture of 23 patients, type C fracture of 2patients, type D1 fracture of 11 patients. Divided into A, B, C, D four groups,four kinds of surgical treatment.In group A of 23 patients, there are 8 patients of type A2, 6 patients of type B1 and 9 patients of type B2, line volar open reduction and hollow screw fixation. In group B of 34 patients, there 7 patients of type A2, 12 patients of type B1, 14 patients of type B2 and 1 patients of type D1, line closed reduction and percutaneous hollow screw internal fixation. In group C of 12 patients, there are 2 patients of type C and 10 patients of type D1, line scaphoid fractures open bone graft and internal fixation, radial styloid process. In group D of 1 patient with type D1 slitting line volar Russe hollow screw internal fixation of bone graft.Rescults: All of the postoperative patients were followed up, an average of 18months(8 to 30 months). Group A: fracture healing time of 9 ~ 32 weeks postoperatively, an average of 19 weeks, dorsiflexion 55 ° ~ 80 °, 70 ° on average, bending to the palm 59°~85°, an average of 78°; radial deviation of13°~18°,15° on average, ulnar deviation 28°~41°,34° on average. Activity for the healthy side of 89%(80% ~ 95%), grip strength with an average of 30kg(27 ~ 42 kg), to the contralateral 92%(88% ~ 105%). Cooney wrist score:excellent 14 cases, good 8 cases, fair 2 cases, the fine rate was 90.3%.DASH score: 5 ±3.1 points.PRWE score: 20 cases of 0-20 points,3 cases of 21-35 points. In group B, one postoperative patient with fracture of Dl 6 months after fracture healing, lines healed after debridement and bone fixation treatment.The rest of the patients with fracture healing time is 8 ~ 32 weeks, an average of 18 weeks, dorsiflexion 60 ° ~ 80 °, 74 ° on average, bending to the palm63°~90°,82° on average; radial deviation of 14°~20°,16° on average, ulnar deviation 30°~45°,37° on average. Activity for the healthy side of 93%(85% ~100%), grip strength with an average of 36 kg(32 ~ 47 kg), to the contralateral96%(92% ~ 108%). Cooney wrist score: excellent 23 cases, good 8 cases, fair2 cases, the fine rate was 91.1%. DASH score: 3±3.1points.PRWE score: 30 cases of 0-20 points, 4 cases of 21-35 points.In group C,fracture healing time of 14 ~ 32 weeks postoperatively, an average of 20 weeks, dorsiflexion 53° ~78 °, 68 ° on average, bending to the palm 57°~83°,76° on average; radial deviation of 13°~17°,14° on average; ulnar deviation 28°~38°,34° on average. Activity for the healthy side of 87%(78% ~ 94%), grip strength with an average of 27 kg(25 ~ 38 kg), to the contralateral 85%(82% ~ 95%).Cooney wrist score: excellent 7 cases, good 8 cases, fair 2 cases, the fine rate was 83.3%. DASH score: 6±3.1 points.PRWE score: 9 cases of 0-20 points,3 cases of 21-35 points. There were no postoperative complications such as Joint instability, obviously pain, residual deformities. In group D 18 weeks after fracture healing, grip strength an average of 90% of the healthy side. Wrist motion: dorsiflexion 70 °; bending to the palm 80°;radial deviation of 15°;ulnar deviation 35°. Activity for the healthy side of 87%, grip strength with an average of 30 Kg, to the contralateral 89%. DASH score: 6.4 points. PRWE score: 15 points.Conclusion: Hollow screws to treat wrist scaphoid fracture healing rate is high,the postoperative effect is remarkable.