Wrist arthroscopy-assisted percutaneous Kirschner wire fixation for fresh scaphoid fractures

Abstract

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 0.05), bone healing time was (11.8 ±1.4)weeks and (13.2±2.4)weeks 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. Key words: Wrist injuries; Scaphoid bone; Arthroscopy; Fracture fixation, internal