Luria Shai, Schwarcz Yonatan, Wollstein Ronit, Emelife Patrick, Zinger Gershon, Peleg Eran
Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Hand Surg Am. 2015 Mar;40(3):508-14. doi: 10.1016/j.jhsa.2014.11.008. Epub 2015 Jan 9.
Scaphoid fractures are classified according to their 2-dimensional radiographic appearance, and transverse waist fractures are considered the most common. Our hypothesis was that most scaphoid fractures are not perpendicular to the longitudinal axis of the scaphoid (ie, not transverse).
Computerized 3-dimensional analyses were performed on 124 computed tomography scans of acute scaphoid fractures. Thirty of the fractures were displaced and virtually reduced. The angle between the scaphoid's first principal axis (longitudinal axis) and the fracture plane was analyzed for location and displacement. The distal radius articular surface was used to depict the volar-dorsal vector of the wrist.
There were 86 fractures of the waist, 13 of the distal third, and 25 of the proximal third. The average angle between the scaphoid longitudinal axis and the fracture plane was 53° for all fractures and 56° for waist fractures, both differing significantly from a 90°, transverse fracture. The majority of fracture planes were found to have a volar distal to dorsal proximal (horizontal oblique) inclination relative to the volar-dorsal vector.
Most waist fractures were horizontal oblique and not transverse. According to these findings, fixation of all fractures along the longitudinal axis of the scaphoid may not be the optimal mode of fixation for most. A different approach may be needed in accordance with the fracture plane.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
舟骨骨折根据其二维放射学表现进行分类，其中腰部横行骨折被认为最为常见。我们的假设是，大多数舟骨骨折并非垂直于舟骨的纵轴（即并非横行）。
对124例急性舟骨骨折的计算机断层扫描进行三维分析。其中30例骨折发生移位并进行了虚拟复位。分析舟骨第一主轴线（纵轴）与骨折平面之间的角度，以确定骨折位置和移位情况。以桡骨远端关节面来描绘腕关节的掌背向量。
腰部骨折86例，远端三分之一骨折13例，近端三分之一骨折25例。所有骨折中，舟骨纵轴与骨折平面的平均角度为53°，腰部骨折为56°，均与90°的横行骨折有显著差异。大多数骨折平面相对于掌背向量呈掌侧远端至背侧近端（水平斜行）倾斜。
大多数腰部骨折为水平斜行而非横行。根据这些发现，沿舟骨纵轴固定所有骨折可能并非大多数骨折的最佳固定方式。可能需要根据骨折平面采用不同的方法。
研究类型/证据水平：诊断性研究II级。
