OBJECTIVE: To explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation. METHODS: The clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation. RESULTS: All patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation ( t=12.851, P<0.001; t=-14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair. CONCLUSION Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.
Male ; Humans ; Female ; Adult ; Fractures, Bone/surgery* ; Bone Wires ; Scaphoid Bone/injuries* ; Retrospective Studies ; Fracture Fixation, Internal/methods* ; Fractures, Ununited/surgery* ; Wrist Injuries/surgery* ; Bone Screws ; Hand Injuries ; Treatment Outcome

OBJECTIVE: To investigate the clinical efficacy of needle-guided percutaneous cannulated compression screw fixation in the treatment of acute non-displaced scaphoid fracture of wrist. METHODS: The clinic data of twenty-eight patients with acute non-displaced scaphoid fracture from January 2014 to January 2019 were analyzed retrospectively. According to the intraoperative method of placement of cannulated screw, they were divided into Guide group(16 patients)and Conventional group(12 patients). There were 13 males and 3 females in Guide group, aged from 20 to 60 years old with an average of(31.42±9.71)years old;5 patients were classified as type A2, 3 patients were classified as type B1 and 8 patients were classified as type B2 according to Herbert classification;they were treated with percutaneous cannulated compression screw fixation under the guidance of needle. There were 11 males and 1 female in Conventional group, aged from 23 to 61 years old with an average of(30.51±7.52)years old;5 patients were classified as type A2, 2 patients were classified as type B1 and 5 patients were classified as type B2 according to Herbert classification;they were treated with conventional percutaneous cannulated compression screw fixation. The operation time, screw angle relative to the longitudinal axis of the scaphoid and wrist function score were assessed and compared between the two groups. RESULTS: A total of 28 patients were followed up from 20 to 45 months with an average of (33.00±8.72) months. None of patients had intraoperative complication and incision infection. These patients returned to work gradually 2 weeks after operation, and all fractures healed within 12 weeks. The operation time in the Guide group was significantly less than that in the Conventinal group(P<0.05). Screw angle relative to the longitudinal axis of the scaphoid in the Guide group was significantly smaller than that in the Conventional group(P<0.05). There was no significant difference in Mayo wrist function scores at the last follow-up between the two groups(P>0.05). During the follow-up period, none of the 28 patients showed internal fixation displacement, arthritis, scaphoid necrosis and other complications. CONCLUSION In the treatment of acute non-displaced scaphoid fractures, the operation time of needle-guided percutaneous cannulated headless compression screw fixation is significantly shorter than that of conventional percutaneous screw fixation, and the screw axis is easier to be parallel to the longitudinal axis of the scaphoid.
Male ; Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Fractures, Bone/surgery* ; Scaphoid Bone/surgery* ; Wrist ; Retrospective Studies ; Syringes ; Wrist Injuries/surgery* ; Fracture Fixation, Internal/methods* ; Bone Screws ; Treatment Outcome

Objective: The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns. Methods: We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits. Results: The injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up. Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.
Adult ; Beijing ; Burns, Electric ; surgery ; Humans ; Male ; Retrospective Studies ; Surgical Flaps ; statistics & numerical data ; Thigh ; Wound Healing ; Wrist Injuries ; surgery ; Young Adult

PURPOSE: Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity. METHODS: We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry. RESULTS: In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studies, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again. CONCLUSION: We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.
Comorbidity ; Female ; Follow-Up Studies ; Glass ; Hand ; Humans ; Lacerations* ; Mood Disorders ; Outpatients ; Retrospective Studies* ; Self Mutilation ; Suicide ; Surgery, Plastic ; Wounds and Injuries ; Wrist*

PURPOSE: We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. MATERIALS AND METHODS: 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 microg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. RESULTS: The PN group (391.2+/-171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8+/-59.0 sec) and PV2 (211.4+/-58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4+/-149.6 sec) than PV1 (557.6+/-194.9 sec) and PV2 (561.5+/-129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). CONCLUSION: The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.
Adult ; Anesthetics, Local/*administration & dosage/adverse effects ; Brachial Plexus/*drug effects/*ultrasonography ; Brachial Plexus Block/adverse effects/*methods ; Female ; Forearm/surgery ; Hand/surgery ; Humans ; Injections ; Male ; Middle Aged ; Peripheral Nerves/ultrasonography ; Prospective Studies ; Single-Blind Method ; Treatment Outcome ; *Ultrasonography, Interventional ; Upper Extremity/innervation/*surgery ; Vascular System Injuries/etiology ; Wrist/surgery

OBJECTIVETo compare clinical effect of T-shaped locking internal fixation and external fixation in treating dorsal Barton's fracture,and investigate selective strategy of internal fixation.

METHODSFrom January 2008 to January 2013, 100 patients with dorsal Barton's fracture were randomly divided into two groups. In treatment group, there were 30 males and 20 females with an average age of (33.8±3.6) years old;30 cases were type B, 20 cases were type C;and treated with T-shaped locking internal fixation. In control group, there were 32 male and 18 females with an average age of (32.9±3.4) years old; 29 cases were type B, 21 cases were type C; and treated with external fixation. Volar tilt, ulnar deviation and radial height at 3 months after operation were detected and compared between two groups. Mechara functional evaluation were used to evaluate postoperative clinical effects. Clinical cure time, postoperative complications,joint mobility and function score were recorded and compared between two groups.

RESULTSIn treatment group,volar tilt was (11.9±2.7)°, ulnar deviation was (20.8+ 2.9)°,and radial height was (10.9±1.8) mm; while volar tilt was (9.1±1.6)°, ulnar deviation was (17.1±2.9)°, and radial height was (8.1±1.5) mm in control group. Treatment group was better than control group in volar tilt, ulnar deviation and radial height. Clinical cure time in treatment group was(12.0±2.3) weeks, shorter than control group (18.0±4.1) weeks. The incidence of complications in treatment group was lower than control group. According to Mehara functional evaluation,20 cases got excellent results, 25 good, 3 moderate and 2 poor in treatment group; 16 cases got excellent results, 14 good, 10 moderate and 10 poor in control group. Treatment group was better than control group in clinical effects.

CONCLUSIONT-shaped locking internal fixation with postoperative functional exercise for the treatment of dorsal Barton's fracture fits for biomechanics demands,and has advantages of stable fixation,rapid recovery, less complications and good functional recovery, it has better clinical effects.

Adult ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation ; instrumentation ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Radius Fractures ; surgery ; Wrist Injuries ; surgery

OBJECTIVETo investigate application of the bone flap pedicled on the retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B.

METHODSFrom October 2007 to October 2011,41 patients with old scaphoid bone fractures of type AO-B were treated by transplantation of the bone flap pedicled on the retrograde branch of radial artery including 26 males and 15 females with an average of (27.3±4.5) years old ranging from 16 to 43 years old. The courses before operation ranged from 6 to 22 months with an average of 11 months. All fractures belonged to the type B of AO classification, that is old wrist fracture of scaphoid bone. All patients' wrist function (pain, function, motion, grip strength) were evaluated by Cooney's modifiedwrist scoring system before and 6 months after operation,and the conditions of bone healing were observed during the follow-up time.

RESULTSAmong them, 36 patients were followed up from 4 to 15 months with an average of 8.3 months. The wounds were healed well without other complications as infection appearing. X-rays or CT confirmed that all fractures were healed completely. The Cooney wrist score was improved from preoperative 53.61±13.97 to postoperative 81.81±8.71 (P<0.01).

CONCLUSIONThe operation of transplantation of the bone flap pedicled on the retrograde branch of radial artery is an effective method to treat old scaphoid bone fractures,which is scientific and has curative effects, and valuable for clinical application.

Adolescent ; Adult ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Radial Artery ; injuries ; surgery ; Scaphoid Bone ; blood supply ; injuries ; surgery ; Surgical Flaps ; Wrist Injuries ; surgery ; Young Adult

OBJECTIVETo dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.

METHODSFrom Oct. 2009 to Oct. 2012, 10 cases of electrical burn wounds on the wrist were treated. A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis. At the midpoint of the line, Doppler flow imaging meter was used to detect the emerging point of perforator vessel. The flap was designed and harvested. The flap was transferred reversely, with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases. The wounds in the donor sites were closed directly in 2 cases, and with skin graft in 8 cases.

RESULTSAll the 10 flaps survived completely. 7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively, which resovled 1 week later. Sub-flap tissue necrosis and infection happened in 2 cases, which healed after dressing and drainage. Patients were followed up for 3-36 months with satisfactory results.

CONCLUSIONSThe middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply. It offers a new choice for the electric burn wound on the wrist, especially at the ulnar side.

Burns, Electric ; surgery ; Forearm ; Humans ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; blood supply ; transplantation ; Ulnar Artery ; Wrist Injuries ; surgery

INTRODUCTIONArthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital.

METHODA total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6-31) months.

RESULTSMean pre- and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34-82) and 17 (range 0-48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes.

CONCLUSIONWhen treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.

Adult ; Arthralgia ; diagnosis ; etiology ; surgery ; Arthroscopy ; methods ; Female ; Humans ; Hypertrophy ; Male ; Middle Aged ; Pain Management ; Synovectomy ; Synovial Membrane ; pathology ; Wrist Injuries ; diagnosis ; etiology ; surgery ; Wrist Joint ; surgery

OBJECTIVETo explore the curative effect of reverse bi-pedicle posterior interosseous artery perforator flap in repairing skin and soft tissue defects on the wrist.

METHODSSeven patients with soft tissue defects on the wrist, including simple skin and soft tissue defects in 4 cases and skin and soft tissue defects combined with radial tendon injury in 3 cases, were hospitalized from December 2010 to March 2012. The area of skin defect on the volar side of the wrist ranged from 4.8 cm x 4.0 cm to 6.2 cm x 4.5 cm, while that on the dorsal side ranged from 3.5 cm x 3.2 cm to 6. 5 cm x 5.4 cm. These wounds were respectively caused by traffic injury (3 cases), reamer injury (2 cases), burn (1 case), and tumor resection (1 case). Reverse bi-pedicle posterior interosseous artery perforator flaps were used to repair these defects, with area of one pedicle ranging from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm and the area of the other pedicle ranging from 2.5 cm x 2.5 cm to 4.0 cm x 3.0 cm. The donor sites were closed by suturing.

RESULTSAll flaps survived completely. Patients were followed up for 6 to 36 months. The color, texture, and appearance of all flaps were satisfactory. At last follow-up, distances of two-point discrimination of flaps ranged from 9 to 13 mm. The dorsal extension and palmar flexion functions of wrist were satisfactory. The results of function evaluation of 7 wrists were excellent in 6 cases and good in 1 case according to the tentative standards for the evaluation of upper extremity function of Society of Hand Surgery of Chinese Medical Association. A linear scar was formed at the donor site.

CONCLUSIONSThe reverse bi-pedicle posterior interosseous artery perforator flap, with advantages of flexible design, easy to achieve, less injury to donor site, and reliable blood supply, etc., is another choice for repairing skin and soft tissue defects over the wrist.

Burns ; Cicatrix ; Humans ; Perforator Flap ; blood supply ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Tendon Injuries ; Treatment Outcome ; Ulnar Artery ; Wound Healing ; Wrist Injuries ; surgery