Comparison Of Two Ways In The Treatment Of Old Scaphoid Fracture

Objective: Scaphoid fracture is the most commonly injured of the carpalbone, accounting for71.2%of all fractures of the carpal,and its incidence isjust less than distal radius fractures, because the special supply of blood caneasily lead to delayed union or no-union. Currently,Radial styloid resection,bone grafting internal fix with K-wire and the Herbert screw internal fixationare commonly used in the treatment of old scaphoid fracture due to theirsimple procedure and good efficacy. This experiment by follow-uppostoperative x-ray results, aims at evaluating the differentiation of the bonefracture healing time and healing rate of fracture of old scaphoid fracturebetween patients treated with the two methods.Methods: From January2010to September2011.33patients with oldscaphoid fracture were recruited to the study from the Third Hospital ofHebei Medical University, all cases were randomly divided into2groupsincluding experimental group and control group,respectively17and16cases.The experimental group: After brachial plexus block anesthesia or localinfiltration anesthesia success, use from nasopharyngeal fossa to styloidprocess of radius about4-5cm arc incision, protecting superficial branch ofradial nerve and cephalic vein. Longitudinally cut tendinous sheath of styloidprocess of radius, in the sheath find tendon of musculus abductor pollicisbrevis and tendon of musculus abductor pollicis longus,and pull them to inside.Along radius inferior dorsal margin opened capsula articulation, with scalpelor periosteum screwdriver split wrist radial side vice ligament, revealing theradial styloid process, with bone chisel cut styloid process of radius, the cutstyloid should not be too small. The standard was when wrist lean30°toradial side the cut bone place of radius cannot touch the scaphoid's fractureline. Cleaning the fibrous tissue and sequestrum from the fracture department, made a rectangular groove and implant spongy bone from radial styloidprocess at both fracture ends with bone chisels and bone curette. To reducefracture from distal segment to proximal segment get anatomical reduction,drilled into two pieces of K-wire, from distalis of scaphoid to proximal end,then repaired joint capsule and sutured the wound. Plaster fixed until thefracture union, removed plaster brake and started wrist joint exercises.The control group: After brachial plexus block anesthesia or localinfiltration anesthesia, made4-5cm arc surgery incision at nasopharyngealfossa and protected superficial branch of radial nerve and cephalic vein.Longitudinally cut tendinous sheath of styloid process of radius, in the sheathfind tendon of musculus abductor pollicis brevis and tendon of musculusabductor pollicis longus, and pull them to inside. Along radius inferior dorsalmargin opened capsula articulation, revealed scaphoid bone's fracture line.Cleaned sequestrum and fibrous that located fracture ends, first drilled into a0.8mm K-wire which was as a guide pin from proximal end of scaphoid todistalis end, along the bone's longitudinal axis. Then parallelly drilled intoanother K-wire (did not pass joint surface), to prevent fracture moving ofproximal segment. C-Arm fluuorroscope was used to determine the position offracture line and guide pin. Measured the length and along the guide pindrilled into a Herbert screw of suitable length, Herbert screw's inserting angleshould be at a45°to sagittal and frontal plane respectively,ensured thefracture fixed firmly, caudal end of Herbert screw should be buried under thecartilaginous superficies of scaphoid. Be sure the fracture was firmly fixedwhen wrist was moved. After thoroughly washed the wound and stoppedbleeding, then sutured. Performed plaster fix until the fracture union.Results:33patients of old scaphoid bone fracture were treated withRadial styloid resection,bone grafting internal fix with K-wire and the Herbertscrew internal fixation, performed plaster fixation after operation and removedthe sutures after12-14days, all patients' wound healing fine. All patients werefollow-up for6-12weeks, reexamined by X-ray shown：33cases scaphoidbone had a complete shape, no bone necrosis or collapse, all old fractures of scaphoid bone were healed satisfactorily, there were no joint instability, painor other complications. The results were as follows: the experimental group:6cases achieved bone union postoperative6weeks,8cases achieved boneunion postoperative8weeks, postoperative10weeks healed2cases,1casepostoperative12weeks got healing. The control group:5cases healedpostoperative6weeks,9cases healed postoperative8weeks, postoperative10weeks healed1cases,1case postoperative12weeks got healing. Confirmedachieved bone union by postoperative X-ray results, then removed plaster andstarted function exercise.From the standpoint of fracture union, the difference was no statisticallysignificant between the two ways in the treatment of old scaphoidfracture(X~2=0.453, P>O.05)Conclusions: There are many ways to treat old scaphoid fracture, eachwith advantages and disadvantages. Radial styloid resection,bone graftinginternal fix with K-wire and the Herbert screw internal fixation are widelyused to treat old scaphoid fracture and no significant differences atdifferentiation of the bone fracture healing time and healing rate of fracture.Compared with other ways, radial styloid excision bone grafting and internalfixation with K-wire operates more simply and with a low cost; Partly resectedstyloid process of radius can eliminate the stress between styloid process ofradius and fracture area of scaphoid and reduce probability of trauma arthritis,conduced to fracture healing; resected styloid process of radius can supplyspongy bone for bone grafting, reduce the injury of taking bone. Take boneand plant bone, drill fixed K-wire can be completed in a incisional area.K-wire's tail is placed subcutaneous tissue, and taken out easily, which canavoid damage to the joint capsule by another surgery, this method can reducethe probability of infection and tissue scar, is a effective way to treat oldscaphoid fracture and should be applied widely.