Moritomo Hisao
Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, 2-2-3 Ukita, Kita-ku, Osaka-shi, Osaka, 530-0021, Japan,
J Orthop Sci. 2014 May;19(3):379-83. doi: 10.1007/s00776-014-0546-y. Epub 2014 Feb 18.
The magnitude of carpal instability following scaphoid fracture is closely related to the fracture location. Middle-third fractures of the scaphoid are classified into B1 (distal oblique fractures) and B2 (complete waist fractures). Deciding preoperatively whether a fracture is B1 or B2 is clinically important, because several studies have revealed that B1 is more stable than B2. Dorsal intercalated segment instability deformity often develops in B2, creating a large, wedge-shaped bone defect, while minimal humpback deformity develops in B1, and the bone defect is much smaller, even after long-standing nonunions. However, determination of the fracture types using X-rays may be less accurate than using three dimensional computed tomography. This article suggests two radiographic clues for estimation of post-fracture carpal instability along with a treatment protocol for each fracture type.
舟骨骨折后腕关节不稳定的程度与骨折部位密切相关。舟骨中1/3骨折分为B1型（远侧斜形骨折）和B2型（完全腰部骨折）。术前判定骨折是B1型还是B2型具有重要临床意义，因为多项研究表明B1型比B2型更稳定。B2型常发生背侧插入节段不稳定畸形，形成大的楔形骨缺损，而B1型仅有轻微驼背畸形，即使长期不愈合，骨缺损也小得多。然而，利用X线判定骨折类型可能不如三维计算机断层扫描准确。本文提出两种影像学线索以评估骨折后腕关节不稳定情况，并针对每种骨折类型给出治疗方案。
