Treatment of carpal navicular fracture with vascularized radial periosteal flap Surgical method A 4-cm longitudinal incision was made through the nasopharyngeal fossa with the apex of the radial tuberosity as the center, protecting the superficial branch of the radial nerve and cephalic vein, observing the distribution of the return branch of the radial artery in the periosteum of the radial tuberosity, and dissecting retrograde to the beginning of the return branch of the radial artery; a 2-cm×0.8-cm periosteal flap with 20 mm×2 mm×2 mm was cut to avoid damaging the trophoblastic vessels. The periosteum was turned over and wrapped around the flap, and the 8/0 non-invasive wire was fixed for 2-3 stitches to create a periosteal flap of the radial tuberosity with the return branch of the radial artery. The radial tuberosity was excised so that it would no longer touch the fracture line of the carpal navicular when the wrist joint was radially deviated; the hole was drilled along the longitudinal axis of the carpal navicular with a 3.5 mm drill, so as not to penetrate the proximal articular surface of the carpal navicular, about 2 cm; the periosteal flap of the radial tuberosity with the return tip of the radial artery was implanted into the carpal navicular bone hole, paying attention to keeping the vascular tip loose to avoid torsion. After the operation, the forearm was fixed in a neutral wrist position with a tubular cast for 3 months. Percutaneous autologous bone marrow transplantation for non-union of navicular fracture: performed under local anesthesia, firstly, an epidural needle is entered from the dorsal side of the radial wrist under X-ray television fluoroscopy, with a 5 ml syringe attached to the end of the needle, avoiding the radial artery and its branches and the superficial branch of the radial nerve, and aspirating whether there is blood return while entering the needle, reaching the fracture site accurately. The scar tissue at the site of bone discontinuity is peeled off with the needle tip to facilitate uniform bone marrow diffusion and infiltration, and the puncture needle is retained. Use a bone puncture needle connected to a syringe to puncture the anterior superior iliac spine or posterior superior iliac spine, extract 5-10 ml of red bone marrow, connect the puncture needle at the site of bone disconnection immediately after extraction, and inject the bone marrow into the bone disconnection slowly and under pressure. One injection is sufficient. After the operation, the wrist is fixed with an elastic band, which avoids wrist movement and does not affect the functions of the fingers such as grasping and pinching. There are more treatment methods for old fractures of the navicular bone, but the treatment results are not satisfactory. The navicular bone has poor blood flow due to its special anatomical relationship, which, together with intra-articular fractures, makes surgical internal fixation difficult, and incision easily damages the trophoid vessels of the navicular bone and leads to the occurrence of traumatic arthritis. The osteogenic property of red bone marrow can effectively promote the healing of fracture and bone discontinuity, which has been fully confirmed by many scholars in basic cytological research, animal experimental research and clinical application, etc. The osteogenic mechanism of bone marrow lies in the potential of bone marrow stromal cells to differentiate into different cell lines and have strong mitotic force. mitotic force. Among them, deterministic osteogenic precursor cells (dopc) with osteogenic effect can differentiate into osteoblasts in in vitro culture and in vivo implantation in a specific environment, and can stimulate other cells in the recipient area to transform into osteoblasts and chondrocytes, and have the role of synthesizing bone matrix, and red bone marrow hematoma injected into the broken end of bone contains a large number of bone growth factors and bone progenitor cells that promote bone tissue regeneration, and can differentiate into bone crust tissue to promote the healing of The healing of bone discontinuity. (1) Before injection, a thick needle for injecting bone marrow blood should be used to separate the scar tissue in the axial direction of the bone discontinuity to facilitate the spread of bone marrow blood. Then the needle is positioned at the bone discontinuity for injection. (2) When taking bone marrow blood, within 5-10 ml can be taken from 1 site, such as anterior and posterior superior iliac spine; if it is more than 10 ml, it needs to be taken from more than 2 sites, and if it is still taken from 1 site, peripheral blood will be the main cause of dilution. The sampling site is preferable to the posterior superior iliac spine, and the amount can be taken in a larger amount. (3) The speed of taking and injecting should be fast, and the bone marrow blood should be transferred to the operator for injection immediately after the assistant draws it, otherwise it is extremely easy to coagulate and difficult to inject. (4) Because of the high pressure during injection, it is necessary to prevent ejection. Percutaneous autologous bone marrow blood injection is less traumatic, simple and safe to operate. Autologous bone marrow is widely available and easy to take. Using local anesthesia, patients can be treated on an outpatient basis, reducing medical costs and alleviating the economic burden of patients, and it is an effective method for the treatment of navicular bone discontinuity.