Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus m...Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.展开更多
BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored...BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.展开更多
探讨跟骨钉中钉手术较传统手术方式治疗跟骨骨折的优势.回顾性收集自2021年4月—2024年4月间跟骨骨折Sanders分型Ⅱ-Ⅲ型46例患者临床资料,根据治疗方式不同随机分为微创组(采用跟骨钉中钉内固定系统微创治疗,23例)和传统组(传统切开复...探讨跟骨钉中钉手术较传统手术方式治疗跟骨骨折的优势.回顾性收集自2021年4月—2024年4月间跟骨骨折Sanders分型Ⅱ-Ⅲ型46例患者临床资料,根据治疗方式不同随机分为微创组(采用跟骨钉中钉内固定系统微创治疗,23例)和传统组(传统切开复位内固定治疗,23例),记录两组术前待术时间、手术时间、术后住院时间、术中出血量、手术并发症、术后1周、1月及1年功能恢复等情况,并进行比较,采用SPSS 23.0软件进行统计学分析,并于末次随访时按照Maryland足部评分系统评分.微创组与传统组患者在平均手术时间(78min vs 105min)、术中出血量(9.5ml vs 55ml)、Maryland足功能评分系统判定术后1周、术后1月及1年优良率(分别73.91%vs 43.48%,91.3%vs 78.2%,100%vs 91.3%)间差异均具有统计学意义(P<0.01).钉中钉内固定系统在跟骨骨折较以往传统切开复位内固定手术有明显优势,可缩短住院时间,术后功能恢复亦较良好,值得推广应用.展开更多
文摘Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.
文摘BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.
文摘探讨跟骨钉中钉手术较传统手术方式治疗跟骨骨折的优势.回顾性收集自2021年4月—2024年4月间跟骨骨折Sanders分型Ⅱ-Ⅲ型46例患者临床资料,根据治疗方式不同随机分为微创组(采用跟骨钉中钉内固定系统微创治疗,23例)和传统组(传统切开复位内固定治疗,23例),记录两组术前待术时间、手术时间、术后住院时间、术中出血量、手术并发症、术后1周、1月及1年功能恢复等情况,并进行比较,采用SPSS 23.0软件进行统计学分析,并于末次随访时按照Maryland足部评分系统评分.微创组与传统组患者在平均手术时间(78min vs 105min)、术中出血量(9.5ml vs 55ml)、Maryland足功能评分系统判定术后1周、术后1月及1年优良率(分别73.91%vs 43.48%,91.3%vs 78.2%,100%vs 91.3%)间差异均具有统计学意义(P<0.01).钉中钉内固定系统在跟骨骨折较以往传统切开复位内固定手术有明显优势,可缩短住院时间,术后功能恢复亦较良好,值得推广应用.
