Mayo Wrist Function Score Research Articles

Surface electromyographic characteristics of forearm muscles after ulnar and radius fracture inchildren.

To evaluate the characteristics of forearm muscle activity in children with ulnar and radius fractures during different follow-up periods by surface electromyography. A retrospective analysis was performed on 20 children with ulnar and radius fractures treated with an elastic intramedullary nail from October 2020 to December 2021. All children were treated with transcubital casts after surgery. At 2 months and before taking out the elastic intramedullary nail, surface electromyographic signals were collected on the flexor/extension of the wrist and the maximum arbitrary isometric contraction of the grip strength in the forearm flexor and extensor muscles of the forearm. The root-mean-square values and integrated EMG values of the superficial flexor and extensor digitalis of the healthy side and the affected side were collected at the last follow-up and 2 months after surgery, and the co-systolic ratio was calculated. The root-mean-square values and co-systolic ratio were compared and analyzed, and the Mayo wrist function score was evaluated. The mean follow-up time was (8.4 ± 2.85) months. Mayo scores were (87.42 ± 13.01) and (97.69 ± 4.50) points at the last follow-up and two months after surgery, respectively (p < 0.05). In the test of grip strength, 2 months after surgery, the grip strength of the affected side was lower than that of the healthy side (p < 0.05), and the maximum and mean values of the superficial flexor of the affected side were lower than those of the healthy side (p < 0.05). At the last follow-up, there was no difference in the grip strength between the affected side and the healthy side (p > 0.05), and no difference in the maximum RMS, mean RMS and cooperative contraction ratio of the superficial flexor and digital extensor muscles between the affected side and the healthy side (p > 0.05). Satisfactory results can be obtained after elastic intramedullary napping in children with ulnar and radius fractures. However, 2 months after surgery, the grip strength of the affected side is small, and the electrical activity of the forearm muscle is low during flexion and extension activities of the wrist joint, which has not returned to normal, suggesting that children orthopaedic clinicians should remind children to conduct timely and effective rehabilitation training after the removal of the cast.

Comparative effectiveness of three treatment options for slade and dodds grade III-IV scaphoid nonunion: a retrospective study

ObjectiveTo compare the clinical efficacy of open debridement screw fixation combined with bone grafting, percutaneous screw fixation, and percutaneous screw fixation combined with injection of platelet-rich plasma (PRP) for the treatment of Slade and Dodds Grade III to IV scaphoid nonunion (SNU).MethodsThis retrospective study included patients with Grade III (25 patients) and Grade IV (28 patients) SNU. They were treated with open surgery bone grafting and internal fixation (group A), percutaneous screw fixation (group B) or percutaneous screw fixation and PRP injection (group C) from January 2015 to May 2020. The fracture consolidation rate, VAS score, and Mayo wrist function score were compared across the three groups.ResultsThe consolidation rate was not significantly different among the three groups for both Grade III and IV SNU. However, patients in group C reported significantly less pain and better wrist function 7 days after surgery compared to group A and B, for both nonunion grades. At 3 months after surgery, group C had significantly better VAS and Mayo wrist scores compared to group A for both nonunion grades, and compared to group B for Grade IV SNU. At 6 and 12 months after surgery, patients with Grade IV SNU in groups A and C had significantly better VAS and Mayo wrist scores compared to group B.ConclusionThis study suggests that percutaneous screw fixation with PRP injection could be a more effective method for treating Grade IV SNU. This approach may reduce postoperative wrist pain and improve wrist function in the early stages after surgery for patients with both Grade III and IV SNU.Type of study/level of evidenceIV.

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

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. 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. All patients were followed up for 6-18months (mean follow-up duration: 10.38 ± 2.69months). 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). 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.

Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study

PurposeThe purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method.MethodsThis retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups.ResultsThe average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower (P < 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter (P < 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher (P < 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time.ConclusionRobot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture.

Treatment of old scaphoid fracture by radial approach of wrist

Objective To evaluate the clinical efficacy of the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist in the treatment of old scaphoid fracture. Methods From January 2003 to September 2016, 62 cases of old scaphoid fracture nonunion were treated by the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist. The wrist joint was immobilized with a plaster cast postoperatively. X-ray examination was performed 3 months after the operation. If the fracture was not healed, the plaster or brace should be used to continue to fix it until the fracture line was blurred, and the recovery of wrist function should be observed. Results All the patients were follow-up for 6 to 24 months with an average of 18 months. Bone healing was achieved in all the patients, with an average healing time of 6 months. The wrist function was evaluated according to the modified Mayo Wrist Function Score. The results were rated as excellent in 40 cases, good in 15 cases and fair in 7 cases, with the excellent and good rate being 88.7%. Conclusion It is simple and effective to treat old scaphoid fracture with the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist. The surgical trauma is small. Bone grafting and fixation can be completed in the same incision. Key words: Scaphoid bone; Treatment outcome; Old fracture; Surgical approach

Efficacy evaluation of dry arthroscopy technique in wrist arthroscopy for wrist joint injury

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures (including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion), 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months (average 9 months). All the old scaphoid fractures were healed, with the average healing time of 12.6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time. Key words: Wrist injuries; Arthroscopy; Scaphoid bone; Radius fractures

Application of wrist arthroscopy in treating scaphoid nonunion advanced collapse

Objective To investigate the clinical effect of wrist arthroscopy in the treatment of scaphoid nonunion advanced collapse (SNAC). Methods A retrospective case series study was performed on the clinical data of 15 SNAC patients admitted from March 2011 to January 2016. There were 12 males and three females, with a mean age of 32 years (range, 26-43 years). There were nine cases of right wrist injury and six cases of left wrist injury. The injury duration was 14-72 months, with an average of 18 months. According to the evaluation of the extent of wrist joint inflammation involvement under wrist arthroscopy, there were nine cases at SNAC I stage, four at stage II, and two at stage III. Stage I patients underwent wrist arthroscopy assisted radius styloid process resection, scaphoid sclerosis bone removal, and iliac bone grafting and internal fixation. Stage II and III patients underwent wrist arthroscopy assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone. Joint healing time in the first month of fracture and fusion, visual analogue score (VAS) before operation and at the last follow up, joint mobility, and grip strength were recorded. Wrist function was evaluated by modified Mayo wrist function score at the last follow up. Results The patients were followed up for 9-23 months, with an average of 14 months. All cases were seen primary bone healing. The mean time of fracture healing was 11.7 weeks in stage I SNAC patients and the mean healing time was 11 weeks in stage II and III patients in the first month of joint fusion. VAS decreased from (5.9±0.8)points to (1.6±0.9)points. Range of motion of the wrist including the flexion/extension arc and the radial/ulnar deviation arc increased respectively from preoperative (38.7±6.3)°, (28.6±11.2)°, (19.8±1.4)° and (22.7±5.7)° to postoperative (54.1±5.8)°, (43.3±9.3)°, (22.0±1.9)° and (30.3±4.3)°. Grip strength was improved from preoperative (10.7±2.4)kg to postoperative (15.0±1.9)kg (all P<0.05). The modified Mayo wrist score was increased from preoperative (57.9±7.3)points to postoperative (84.5±6.9)points (P<0.05). According to modified Mayo wrist scores, the result was excellent in one case, good in nine cases and fair in five. Conclusions For patients with SNAC, it is necessary to evaluate the staging under wrist arthroscopy. Arthroscopy assisted scaphoid bone grafting can be applied to stage I patients. For stage II and III patients, wrist arthroscopy-assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone is helpful to facilitate bone healing, relieve pain, and improve function. Key words: Scaphoid bone; Fractures, ununited; Arthroscopy; Bone transplantation

Wrist arthroscopy-assisted periosteal cleaning combined with articular capsule repair for type IB triangle fibrocartilage complex lesions

Objective To evaluate the effect of wrist arthroscopy-assisted repair of stable or slightly unstable type I B triangular fibrocartilage complex (TFCC) injury of distal radio-ulnar joint (DRUJ). Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with type I B TFCC injuries admitted from May 2015 to August 2017, including 17 males and 25 females, aged 18-64 years, with an average of 38 years. Among the patients, 20 were injured on the left side, and 22 on the right side. During the operation, if the injury was diagnosed as type I B injury under wrist arthroscopy, outside in method with 3-0 purdis stitch was adopted to repair TFCC after joint cleaning. After the operation, the wrist joint was fixed in a neutral rotation position for 3 weeks with a long arm plaster over the elbow and then replaced with a short arm plaster for 2-3 weeks. Visual analogue scale (VAS), grip strength, joint mobility, modified Mayo wrist function score, and disabilities of arm, shoulder and hand score (DASH) before operation and at the last follow-up were compared. Results All patients were followed up for 6-24 months, with an average of 11 months. No infection or nerve injury occurred after operation. At the last follow up, wrist pain disappeared in 13 cases completely, while 29 cases still had pain during moderate activities. VAS was decreased from preoperative (2.7±0.9) points to (1.2±1.0) points (P 0.05), (40.0±10.6)°(P<0.05), and (148.9±21.4)°(P<0.05). The modified Mayo wrist function score increased from preoperative (67.3±9.6)points to postoperative (84.4±6.7)points. The results were excellent in 13 cases, good in 24, and fair in five, with an excellent and good rate of 88%. The DASH score decreased from (34.6±10.2)points to (10.4±6.5)points after operation (P<0.05). Conclusion For patients with stable or slightly unstable type IB TFCC injury of DRUJ, synovial membrane cleaning under wrist arthroscopy plus capsule repair combined with active rehabilitation training can effectively reduce wrist pain, and improve wrist radial ulnar deviation, forearm rotation and grip strength as well as improve wrist joint function. Key words: Wrist injuries; Arthroscopy; Triangular fibrocartilage; Surgical procedures, minimally invasive

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

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

Clinical research of the open surgery and arthroscopic minimally invasive surgery in the treatment of scaphoid nonunion

Objective To retrospectively analyze the clinical efficacy of traditional open surgery and arthroscopic minimally invasive surgery in the treatment of scaphoid nonunion. Methods A retrospective study was conducted on 42 cases (met the inclusion criteria) of scaphoid nonunion who treated in our hospital from 2008 to 2015, including 22 cases in traditional open surgery group and 20 cases in arthroscopic minimally invasive surgery group. The time of fracture healing, wrist function (according to the modified Mayo wrist function scoring system), visual analogue scale (VAS) were analyzed. Results Postoperatively, the average follow-up time of the open surgery group and arthroscopic minimally invasive surgery group was 27.5 months and 20 months respectively, the healing rate was 95.5% and 95%, and the average healing time was 14.1 weeks and 13.4 weeks. The difference was not statistically significant (P<0.05). The operation time of the open group was significantly shorter than that of the arthroscopy group (P<0.01). The excellent and good rate of modified Mayo wrist function score from the arthroscopy group (94.4%) was higher than that from the open group (80.0%). The VAS of the arthroscopy group 0.7±0.8 was lower than that of the open group 1.1±1.1. There was 1 case of complication in the open group and no in the arthroscopy group. Conclusion Both of the operation methods can achieve satisfactory fracture healing. The wrist function after the arthroscopic minimally invasive surgery is better than that after open surgery with lower pain, less complications and better appearance. However, the technique of arthroscopy surgery is difficult and the operation time is long. Key words: Scaphoid bone; Fractures, ununited; Surgical procedures,operative; Arthroscopes

Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury. Methods From March 2012 to December 2015, 5 patients with established Essex-Lopresti injury, whose radiuses had moved proximally since radial head had been resected in the earlier operation, were operated in our department, including 4 males and 1 female, aged from 25 to 50 years (average, 38.8 years). The interval from the radial head resection to the operation in our department was 2 to 7 months (average, 4.6 months). All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress, and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint. 2 of the 5 cases acquired distal radial-ulnar joint stability after reduction, and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks. The Mayo elbow and wrist function score were used to evaluate pre- and post-operative function, with recording the range of motion of the elbow, forearm and wrist. Results All the 5 patients were followed-up for 24 to 60 months (average 45 months). The Mayo elbow function score was improved from preoperative 62 (range, 45-75) to 96 (range, 80-100) at the latest follow-up. The Mayo wrist functional score was improved from 54 (range, 15-65) to 81 (range, 55-90) at the latest follow-up. All patients got significant improvement of involved upper extremity function, without proximal shifting of radius, radial head prosthesis failure or instability of the distal radio-ulnar joint. Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary. Key words: Radius fractures; Dislocations; Arthroplasty, replacement; Osteotomy

A comparative study of Herbert screw internal fixation and plaster immobilization for the treatment of stable scaphoid fractures

Objective To compare bone union and clinical results following Herbert screw internal fixation or plaster cast immobilization in the treatment of stable scaphoid fractures. Methods A retrospective analysis was conducted of 48 cases of scaphoid fractures with complete treatment and follow-up data. There were 26 patients whose fractures were treated with closed reduction and internal fixation with Herbert screw (group A), while 22 cases were treated conservatively with long-arm plaster cast immobilization (group B). Results Postoperative follow-up duration ranged from 12 to 36 months with an average of 23.7 months. Evaluation at the last follow-up using Mayo wrist function score revealed excellent results in 15 cases, good in 9 cases, and fair in 2 cases in group A, with an overall 92.3% excellent and good rate. In group B the results were rated as excellent in 9 cases, good in 8 cases, fair in 3 cases, and poor in 2 cases. The overall satisfactory rate was 77.3%. Wrist function was better in group A than in group B, the differences being statistically significant (P=0.018). Conclusion Treatment of stable scaphoid fractures with Herbert screws can achieve reliable fixation that allow early functional exercises. The fracture healing time is shorter and wrist function is better. Key words: Scaphoid bone; Fracture fixation, internal; Plaster external fixation

Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures

The purpose of this study was to investigate the effect of untreated triangular fibrocartilage complex (TFCC) tear on the clinical outcome of conservatively treated distal radius fractures. This prospective study comprised 47 consecutive patients who presented at our clinic between January 2009 and January 2010 with displaced radius distal fracture and were treated with closed reduction and casting. During the first 15 days of treatment, all patients underwent wrist MR imaging to detect traumatic TFCC tears. At the final follow-up, all patients were evaluated with Mayo wrist function score and wrist radiographs. Patients were divided into two groups according to presence of TFCC tear, and two groups were analyzed statistically. The mean follow-up period was 38.9 ± 3.5 months (range 36-48). TFCC tear was detected in 24 cases, and remaining 23 cases had no TFCC tear. Both groups were statistically similar regarding age (p = 0.574), gender (p = 0.108), dominant side involvement (p = 0.339), fracture type (p = 0.709) and immobilization period (p = 0.514). According to Mayo wrist score, excellent results were obtained in 21 (44.7%) cases, good in 16 (34.0%) and satisfactory in 10 (21.3%). No significant difference was observed between groups in wrist function scores (p = 0.451). Radiographic measurements were similar between groups (radial length p = 0.835, volar til p = 0.464, radial inclination p = 0.795). Traumatic TFCC tears which are frequently seen together with distal radius fractures do not affect the long-term functional results. Therefore, further diagnostic tests and treatment of TFCC tears in patients with stable distal radius fractures may be unnecessary. However, it should be borne in mind as a reason for continuing wrist pain and instability after distal radius fractures despite proper radiologic recovery.