Scaphoid Waist Fractures Research Articles

Antegrade Versus Retrograde Technique for Fixation of Scaphoid Waist Fractures: A Comparison of Screw Placement

Background Scaphoid waist fractures are often treated using headless compression screws using dorsal or volar approaches. Objectives The purpose of this study is to compare differences in screw position using a volar (retrograde) or dorsal (antegrade) approach. Patients and Methods A total of 82 patients were retrospectively evaluated: 41 treated with a volar and 41 with a dorsal approach were selected. Postoperative radiographs were reviewed by three observers who rated screw location in the proximal pole, waist, and distal pole. Results Thirty-four patients (83%) in the antegrade group had central screw placement in the waist of the scaphoid in posteroanterior and lateral planes compared with 14 (34.9%) in the retrograde group ( p < 0.05). For the antegrade group, the screw was central in 217 of 246 zones (88.2%) compared with 127 of 246 (51.6%) in the retrograde group ( p < 0.05). Conclusions The dorsal antegrade approach appears to allow the surgeon to achieve central screw placement along all three scaphoid regions. Level of Evidence This is Level III study.

Approach to the Perpendicular Fixation of a Scaphoid Waist Fracture—A Computer Analyzed Cadaver Model

In scaphoid fracture screw fixation, the screw is commonly placed along the long axis of the bone, without consideration of the fracture plane. This position is not perpendicular to transverse waist fractures or to the more common horizontal oblique fractures. Our aim was to examine the feasibility and describe possible approaches to, placing a screw perpendicular and in the center of the scaphoid waist fracture. Computed tomography of 12 cadaver wrists was performed in 3 positions to examine possible approaches in flexion, neutral, and extension of the wrist. The scans were evaluated using a 3-dimensional model that simulated horizontal oblique (60°) and transverse (90°) fractures. We examined all possible approaches for screw positioning and their deviation from the axis perpendicular to the fracture and in the center of its plane. The preferred approaches for a perpendicular screw in a horizontal oblique fracture were found to be proximal-dorsal in flexion or transtrapezial in the extended or neutral positions (through the volar-radial trapezium). In transverse fractures, the possible approaches were proximal-dorsal or transtrapezial in the flexed or neutral positions and distal in the extended position (volar to volar-radial trapezium). In these approaches, the screw could be placed perpendicularly (deviating by < 10°) and in the center of the fracture in all specimens. According to this model, it appears feasible to place a perpendicular screw in thecenter of a horizontal oblique waist fracture using a proximal-dorsal approach in flexion ora transtrapezial approach in neutral or extension positions of the wrist. Palpable landmarksmay be used as additional guides to direct these approaches according to the clinical setting. Perpendicular screw fixation of horizontal oblique or transverse scaphoid waist fractures is a possible option, if chosen for its biomechanical advantages.

Treatment of scaphoid waist fracture with wrist arthroscopic-assisted percutaneous internal fixation

Objective To explore the clinical efficacy of the treatment for scaphoid waist fracture assisted by wrist arthroscopy. Methods From January20l5 to December 2017, 12 cases of fresh scaphoid waist fracture were treated with closed reduction and percutaneous Herbert screw fixation assisted by wrist arthroscopy. The healing of fracture was observed by regular X-ray after operation. Results All the patients were follow-up for 6 to 12 months, with an average of 10 months. All the fractures healed, with an average healing time of 8.4 weeks. The wrist function was evaluated by modified Mayo wrist score. The results were rated as excellent in 8 cases and good in 4 cases. Conclusion Percutaneous internal fixation with Herbert screw assisted by wrist arthroscopy for fresh scaphoid waist fracture can achieve satisfactory clinical results. Key words: Scaphoid bone; Fractures,bone; Wrist arthroscopy; Herbert screw

Morphometric Variations of Scaphoid and Safety of Screw Fixation for Its Waist Zone Fractures in Indian Population: A Preliminary Report

Purpose Surgeons fixing scaphoid fractures need to be familiar with their morphological variations and their implications for safe screw placement during fixation. The purpose of this computed tomography (CT)-based study was to analyze the anatomical limits of safe screw placement for scaphoid waist fractures in the Indian population. Methods We measured the coronal and sagittal dimensions of the scaphoid in 3 zones: proximal, waist, and distal, in CT scans of wrists with intact scaphoids obtained from 50 live subjects. In addition, we studied the curvature of the scaphoid, its longitudinal extent, and the safe placement of trajectories for different screw diameters. Results The proximal segment had the narrowest mean coronal width of 6.39 mm, whereas the waist region had the narrowest mean sagittal width of 9.02 mm. Mean scaphoid curvature was 132.23°. Maximal bony extent of the scaphoid was significantly higher than the mean length of screw placed centrally in the mid-waist region. Conclusions This study showed that there is a considerable amount of variation in scaphoid morphometry in Indian patients. All scaphoids capable of safely containing a single 4-mm screw or 2 parallel 1.7-mm screws coplanar in the sagittal plane. Surgeons treating these fractures should consider a CT-based analysis to plan the screw direction and length and need to be familiar with the morphometric variations of the scaphoid. Clinical relevance The measurements and techniques in this study may be helpful in understanding morphometric variations of the scaphoid and in planning surgery for fixation of fractures around its waist region.

Three-dimensional-printed patient-specific Kirschner-wire guide for percutaneous fixation of undisplaced scaphoid fractures: a cadaveric study.

Undisplaced scaphoid waist fractures can be managed by percutaneous fixation. The purpose of this study is to compare percutaneous fixation using a three-dimensional (3-D)-printed guide with the conventional method in a cadaveric study. Twelve wrists were divided into two groups: standard fluroscopic technique group, and a patient-specific 3-D-printed guide group. In the patient-specific group, using high resolution CT scans, we manufactured a mould-guide including a wire guide sleeve aligned with the planned ideal path, and 3-D printed it. On postoperative CT scans we measured the angular deviation of the screw axis from the ideal axis, and compared the two groups. The angular deviation was significantly lower in the patient-specific guide group. We concluded that a 3-D-printed guide for scaphoid percutaneous fixation allows a more accurate placement of the screw than a fluoroscopy guide in our cadaveric model.

Fixation du scaphoïde carpien par vissage palmaire ou dorsal : étude en éléments finis

PurposeScaphoid waist fractures may be fixed through volar or dorsal screw fixation. However, there is no consensus on which surgical fixation method should be performed. The purpose of this study was to compare volar versus dorsal screw fixation of scaphoid waist fractures under physiological loading conditions utilizing finite element analysis. MethodsA transverse scaphoid waist fracture (Herbert type B2) model was fixed with a headless cannulated compression screw using either a volar or dorsal approach. Displacement and rotation of the fragments and stress analysis on the scaphoid bone and screw were analyzed in the models using 3D finite element analysis in three different wrist positions; total extension (TE), neutral (N) and total flexion (TF). ResultsDisplacement of the fracture gap in volar fixation in all planes (x, y, z) was less than in dorsal fixation in the TF and N positions. Furthermore, rotational stability was stronger in volar fixation in all planes and wrist positions. Von Mises stress values were concentrated on the proximal fragment in all wrist positions. ConclusionsAlthough both volar and dorsal fixation techniques can be preferred in Herbert type B2 fractures, results of this finite element analysis suggest that centrally placed volar compression screw fixation may be biomechanically advantageous over dorsal screw fixation. Level of evidenceI.

Radiographic Accuracy in Scaphoid Waist Fractures

All patients with acute scaphoid fractures treated at our hospital in a 4-year period that had a CT scan and plain radiographs were evaluated. The maximum displacement seen on either AP or lateral X-rays was measured as well as the amount of palmar flexion through the fracture as seen on the lateral X-ray. The differences were calculated and the mean of the sum of the differences was calculated.

Moderate Interrater Reliability in the Diagnosis of Scaphoid Waist Fractures.

Background Conventional radiographs have been shown to yield unreliable results in classifying scaphoid fractures. Computed tomography (CT) has been claimed to be the tool of choice in determining the treatment as well as fracture displacement. Purpose The purpose of the study was to examine the interrater reliability and intrarater reproducibility in the decision-making of the treatment of scaphoid waist fractures. Patients and Methods Fifty-one CT scans of scaphoid waist fractures were utilized. Seven orthopaedic surgeons with a particular interest in hand surgery independently scrutinized the scans classifying each in undisplaced, < 2 mm displaced, or > 2 mm displaced, and suggested a treatment of immobilization in cast or screw fixation. The Fleiss' and Cohen's kappa values using SPSS (Statistical Package for Social Science) version 24 were calculated and interpreted according to Landis and Koch. Results The kappa value representing interrater reliability when choosing between operative or nonoperative treatment was 0.58. Interrater reliability of the distinction between < 2 mm displaced or > 2 mm displaced fractures was 0.61. On average 79.5% of the fractures were suggested treated nonoperatively and 20.5% operatively. Overall, intrarater reproducibility was 0.75 when classifying between < 2 mm displaced or > 2 mm displaced fractures. When choosing between operative or nonoperative treatment, intrarater reproducibility was 0.69. Conclusion Moderate interrater reliability was found when choosing between nonoperative and operative treatment. The use of CT showed substantial reliability in the distinction between < 2 mm displaced and > 2 mm displaced fractures. Intrarater reproducibility was substantial when classifying between < 2 mm displaced and > 2 mm displaced fractures as well as when choosing between operative or nonoperative treatment. Level of Evidence This is a Level III study.

Comparison of volar versus dorsal screw fixation for scaphoid waist fractures: A finite element analysis

PurposeScaphoid waist fractures may be fixed through volar or dorsal screw fixation. However, there is no consensus on which surgical fixation method should be performed. The purpose of this study was to compare volar versus dorsal screw fixation of scaphoid waist fractures under physiological loading conditions utilizing finite element analysis. MethodsA transverse scaphoid waist fracture (Herbert type B2) model was fixed with a headless cannulated compression screw using either a volar or dorsal approach. Displacement and rotation of the fragments and stress analysis on the scaphoid bone and screw were analyzed in the models using 3-D finite element analysis in three different wrist positions; total extension (TE), neutral (N) and total flexion (TF). ResultsDisplacement of the fracture gap in volar fixation in all planes (x, y, z) was less than in dorsal fixation in the TF and N positions. Furthermore, rotational stability was stronger in volar fixation in all planes and wrist positions. von Mises stress values were concentrated on the proximal fragment in all wrist positions. ConclusionsAlthough both volar and dorsal fixation techniques can be preferred in Herbert type B2 fractures, results of this finite element analysis suggest that centrally placed volar compression screw fixation may be biomechanically advantageous over dorsal screw fixation. Level of evidenceI.

Plate Fixation With Cancellous Graft for Scaphoid Nonunion With Avascular Necrosis

Currently, there is no consensus on the optimal treatment for scaphoid nonunion with avascular necrosis (AVN). Various techniques, often involving vascularized corticocancellous bone grafting, have been proposed. The authors hypothesized that similar outcomes might be possible with volar plate fixation augmented with autogenous pure cancellous graft. The authors performed a retrospective chart review of 13 cases of scaphoid nonunions with AVN in 12 patients treated with plate fixation and pure cancellous bone grafting. Surgical management included a volar incision, reduction, impaction of cancellous bone graft from the ipsilateral olecranon and/or distal radius, and application of a volar locking plate. Postoperative outcome measures included time to union based on computed tomography, patient-reported pain and disability scores, grip strength, range of motion, and return to work and sports. The average patient was 32 years old (range, 17-50 years) and treated an average of 18 months after initial injury (range, 6-49 months). Two of 12 patients (15.7%) were female, 3 of 12 patients (25%) were smokers, and 5 of 12 patients (41.7%) had failed union with previous screw fixation. Twelve scaphoids (92.3%) were treated for AVN associated with a proximal pole fracture, and 1 (7.7%) for AVN proximal to a scaphoid waist fracture. Mean follow-up was 19.5 months (range, 12-29 months). Union was achieved in all patients. Two scaphoids (15%) achieved union by 12 weeks, 7 scaphoids (54%) by 18 weeks, 2 scaphoids (15%) by 24 weeks, and 2 scaphoids (15%) by 30 weeks (range, 8.9-28 weeks). Mean Disabilities of the Arm, Shoulder, and Hand score improved from 30.6 ± 6.2 before surgery to 17.2 ± 6.5 after surgery. All 11 employed patients returned to work, although 3 (27.2%) did not return to full capacity. Scaphoid plate fixation and pure nonvascularized cancellous bone grafting for scaphoid nonunion with AVN yields excellent union rates and good patient-reported and functional outcomes. Therapeutic IV.

Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures.

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.

Reliability of Diagnosis of Partial Union of Scaphoid Waist Fractures on Computed Tomography

Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers. CT scans were done 10 to 12 weeks after injury. Observers were asked to "eyeball" measure percentage of union. We found that there was a moderate agreement on the categorical degree of partial union of a scaphoid waist fracture on CT (k = 0.34). Agreement on the location of bony bridging was slight (k = 0.31). We concluded that there is limited reliability of diagnosis of partial union of a scaphoid waist fracture on CT and that this should be taken into account in both patient care and research. This is a Level III, diagnostic study.

Scaphoid fractures treated with a volar percutaneous approach. Analysis and results in 92 cases

ObjectiveHerbert type B1 and B2 scaphoid fractures can be treated by orthopaedic treatment or surgery. The aim of this study is to analyse results and complications of scaphoid waist fractures treated using the percutaneous volar approach. Material and methodWe present a retrospective study of 92 patients, treated in our institution from 2006 to 2016 using a volar percutaneous fixation. Mean Follow-up was 16 months (range 12–48). Injuries were classified using Hebert's classification, including B1 and B2 fracture types; the other fracture types following this classification system were excluded. Polytrauma patients, dorsal approach, fractures associated with distal radius injuries, patients treated using another surgical technique and patients with non follow-up were also excluded. Functional results were evaluated using the DASH questionnaire. Consolidation was established as the presence of bony bridges crossing the fracture site on X-rays, associated with absence of pain. ResultsThe average time to fracture healing was 6.6 weeks (range 5–11). After 12 months of follow-up, the average wrist range of motion was 70° of extension (range 58–75) and 70° of flexion (range 62–80). Regarding functional evaluation, the average DASH questionnaire score was 42. The most frequent complication was non-union in 4 cases (4.44%). Average surgical time was 25min. ConclusionsVolar percutaneous fixation is a simple and quick technique for a specialist surgeon, characterised by low morbidity and complication rates compared to ORIF and orthopaedic treatment, which accelerates the patient's functional recovery.

Surgical treatment by percutaneous anterior screw fixation of scaphoid fractures

The aim of this study was to evaluate the results of percutaneous screw fixation of scaphoid waist fractures in our surgery unit by comparing them with recent data from the literature. This was a retrospective, descriptive study conducted between January 2010 and September 2016. Patients operated due to a recent scaphoid fracture and treated by percutaneous anterograde screw fixation with a Herbert screw were included in this study. Our cohort was a sub-set from a scaphoid fracture group; other fracture sites, other treatment techniques and fractures associated with scapholunate ligament lesions were excluded. The time to union and union rate were recorded. The Youm and McMurtry indices, scaphoid and scapholunate angles were measured on radiographs. A total of 21 patients were included. The mean age was 30 years (18–44) and the sex ratio (male/female) was 9.5. The union rate was 95% with an average follow-up of 24 months. Four patients had a mobility deficit in the sagittal plane of about 9°. No malunion was found, and no major complications were observed. Based on this study, percutaneous fixation of the scaphoid with Herbert's screw is a reliable technique that leads to union in most cases with limited postoperative immobilization.

Conjoint Analysis of Treatment Preferences for Nondisplaced Scaphoid Fractures.

We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture. They then indicated their relative preferences among 13 pairs of alternatives with variations in the following attributes: time in a cast, time in a brace, duration of ongoing soreness, risk of treatment failure (by which we meant scaphoid nonunion), out-of-pocket costs based on estimates of direct costs ($500-2,500), and apprehension about surgery. A conjoint analysis was used to determine the relative importance of these factors when choosing between surgical or nonsurgical management. The factor with the greatest influence on treatment choice was the cost of the procedure. After assessing the respondent's apprehension to undergo surgery, a sensitivity analysis showed the proportion of respondents who would choose surgery given different outcomes. To make the predicted share of those who are "not worried" about surgery equal to those who are "somewhat worried" or "a little worried" would require that the cost of surgery increase by $2,700. In addition, 2 weeks in a cast, 3 weeks in a brace, 2 months of soreness, or a 2% increase in the risk of fracture nonunion generates the same surgical choice probability as a $2,000 increase in the out-of-pocket cost of surgery. As conceptualized in this conjoint analysis, out-of-pocket costs and apprehension about surgery seem to have a greater impact on a decision for surgery than the time spent in a brace or cast and the risk of treatment failure. Economic and decision analysis III.

Autologous iliac bone flap graft with cross Kirschner wire fixation for treatment of scaphoid waist fracture nonunion in young adults

Objective To explore the autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation in the treatment of scaphoid waist fracture nonunion in young adults. Methods From January 2010 and August 2015, 18 cases of scaphoid waist fracture nonunion were treated in our department. According to preoperative MRI evaluation, ischemic necrosis of proximal or distal pole scaphoid was not seen. The incision was made at dorsal radial wrist. Autologous iliac flap grafting and packing combined with cross Kirschner wire and splint fixation were conducted after cleaning up the dead bone of scaphoid nonunion. Postoperatively, injured limb was continuously fixed by splint for 6 weeks. Removal of Kirschner wire was conducted when fracture line blurred showed by wrist X-ray photograph. The patients were guided to gradually strengthen the wrist joint function exercise. Results Postoperative follow-up ranged from 6 to 24 months, with an average of 13 months. All the cases of scaphoid waist fracture nonunion were healed with 2 cases of delayed union. No scaphoid necrosis occurred. Wrist joint stability was achieved. Wrist joint pain disappeared in 16 cases. Two cases still had slightly pain and significantly alleviated compared with preoperative condition. Postoperatively the angle of wrist extension was 38° to 60° (average, 52°), of wrist flexion 36° to 60° (average, 48°). The wrist range of motion obviously improved. Hand grip strength was 42.5 to 55.5 kg (average, 50.6 kg) for male patients and 28.5 to 35.4 kg (average, 32.6 kg) for female patients. Grip strength increased postoperatively and the patients returned to original work. Conclusion Autologous iliac flap graft without blood flow combined with cross Kirschner wire and splint fixation is a good method for treating scaphoid waist fracture nonunion in young adults, because of the simple technique, minor local injuries of wrist, and satisfactory curative effects. Key words: Scaphoid bone; Fractures,bone; Nonunion; Iliac bone flap

Vascularized Bone Grafts for the Treatment of Scaphoid Nonunion

Scaphoid nonunion without treatment can progress to carpal collapse and a predictable pattern of radiocarpal arthrosis. Surgical intervention is indicated to prevent progressive carpal instability and arthritis. In proximal pole nonunion and occasionally in scaphoid waist fracture with osteonecrosis, or when traditional bone grafting has failed to achieve union, vascularized bone grafts are used because they improve the biology of bone healing. This review describes the most common vascularized bone grafts used to treat scaphoid nonunion, either pedicled or free.

Traumatic Bilateral Scaphoid Fracture-A Case Report

Introduction: The largest carpal bone, the scaphoid, is the most commonly injured bone in the wrist joint. While unilateral scaphoid fractures are quite common, bilateral ones are rarely encountered. Existing literature on traumatic bilateral scaphoid fractures is very limited. Case report: We came across a young biker, who sustained bilateral, undisplaced, scaphoid waist fractures following a road traffic accident. He was treated conservatively with bilateral thumb spica casts, and recovered fully in about 12 weeks after the injury. Conclusion: Comprehensive imaging should be done in case of suspected scaphoid fractures, as failure to do so may lead to missed fracture. Although internal fixation reduces healing time, conservative management with thumb spica casts can also successfully treat undisplaced bilateral scaphoid fractures, and the patient can attain full range of motion within a comparable time frame. Surgical management should be favored more in case of displaced/ unstable fractures.

Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting

Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union. Twenty-nine patients with scaphoid non-union were included in this prospective study. There were 27 male and 2 female patients with an average age of 29 years (range 18–45 years). Mean time from the injury to surgery was 18.3 months. The Slade and Geissler classification was used to classify the non-unions. Wrist range of motion (ROM), pain based on a visual analog scale (VAS), and the Mayo wrist score were used to assess the clinical outcomes. Postoperative radiographs and CT-scans were reviewed to assess fracture union, carpal alignment and screw position. The average clinical follow-up was 76 weeks (range: 74–87 weeks) postoperatively. Mean time to union was 11 weeks (range: 7–18 weeks). There was no humpback/no DISI in any of the cases. Twenty-six patients healed successfully with no additional procedures. Three patients with failed union underwent revision surgery with grafting. At the final follow-up, average wrist ROM was 61° (range: 30–80) in extension and 61° (range: 35–80) in flexion, the average Mayo wrist score was 66±20 (range: 20–90), and the mean VAS was 2±2 (range: 0–7). Percutaneous fixation without grafting associated with distal radius core decompression can provide satisfactory outcomes in surgical management of scaphoid non-unions. Level of evidenceII.

Fracturas de escafoides tratadas con técnica percutánea volar. Análisis y resultados de 92 casos

ObjectiveHerbert type B1 and B2 scaphoid fractures can be treated by orthopaedic treatment or surgery. The aim of this study is to analyse results and complications of scaphoid waist fractures treated using the percutaneous volar approach. Material and methodWe present a retrospective study of 92 patients, treated in our institution from 2006 to 2016 using a volar percutaneous fixation. Mean Follow-up was 16 months (range 12-48). Injuries were classified using Hebert's classification, including B1 and B2 fracture types; the other fracture types following this classification system were excluded. Politrauma patients, dorsal approach, fractures associated with distal radius injuries, patients treated using another surgical technique and patients with non follow-up were also excluded. Functional results were evaluated using the DASH questionnaire. Consolidation was established as the presence of bony bridges crossing the fracture site on x-rays, associated with absence of pain. ResultsThe average time to fracture healing was 6.6 weeks (range 5-11). After 12 months of follow-up, the average wrist range of motion was 70° of extension (range 58-75) and 70° of flexion (range 62-80). Regarding functional evaluation, the average DASH questionnaire score was 42. The most frequent complication was non-union in 4 cases (4.44%). Average surgical time was 25min. ConclusionsVolar percutaneous fixation is a simple and quick technique for a specialist surgeon, characterised by low morbidity and complication rates compared to ORIF and orthopaedic treatment, which accelerates the patient's functional recovery.