Werner Frederick W, St-Amand Hugo, Moritomo Hisao, Sutton Levi G, Short Walter H
Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.
Division of Plastic and Reconstructive Surgery, Centre de Santé et de Services Sociaux de Gatineau, Gatineau, Quebec, Canada.
J Wrist Surg. 2016 Mar;5(1):47-51. doi: 10.1055/s-0035-1570396. Epub 2015 Dec 31.
Background Scaphoid fractures are common carpal fractures that are often misdiagnosed as wrist sprains and may go on to nonunion. The location of the fracture site may influence the stability of scaphoid nonunions. Purpose To determine whether the stability of a scaphoid nonunion depends upon the fracture's location, we tested the hypothesis that a simulated fracture distal to the apex of the scaphoid dorsal ridge will have greater interfragmentary motion than proximal. Methods Eleven cadaver wrists were moved through three wrist motions using a wrist simulator. In six wrists, a fracture was created distal to the scaphoid apex, and in five a fracture was created proximal to the apex. Sensors attached to the distal and proximal parts of each scaphoid measured the interfragmentary motion during wrist motion. Results In those wrists in which the scaphoid was sectioned distal to the apex, the distal fragment became significantly more unstable relative to the proximal fragment. It flexed, ulnarly deviated, and pronated. These motion changes were less when the scaphoid was sectioned proximally. Discussion Scaphoid fractures distal to the scaphoid apex will have greater interfragmentary motion. The mobility of the fragments at the fracture site is possibly a more important contributory factor of nonunion in scaphoid waist fractures than for proximal scaphoid fractures. Clinical Relevance Understanding the effect that the location of a scaphoid fracture has on the potential for nonunion may influence the modalities of treatment and follow-up.
舟骨骨折是常见的腕骨骨折，常被误诊为腕关节扭伤，且可能发展为骨不连。骨折部位可能影响舟骨骨不连的稳定性。目的：为了确定舟骨骨不连的稳定性是否取决于骨折部位，我们检验了这样一个假设，即模拟舟骨背侧嵴顶点远端的骨折比近端骨折具有更大的骨折块间运动。方法：使用腕关节模拟器对11个尸体腕关节进行三种腕关节运动。在6个腕关节中，在舟骨顶点远端制造骨折，在5个腕关节中，在顶点近端制造骨折。附着在每个舟骨远端和近端的传感器测量腕关节运动期间的骨折块间运动。结果：在舟骨在顶点远端被切断的那些腕关节中，远端骨折块相对于近端骨折块明显变得更不稳定。它发生屈曲、尺侧偏斜和旋前。当舟骨在近端被切断时，这些运动变化较小。讨论：舟骨顶点远端的舟骨骨折将具有更大的骨折块间运动。骨折部位骨折块的活动度可能是舟骨腰部骨折骨不连比近端舟骨骨折更重要的促成因素。临床意义：了解舟骨骨折部位对骨不连可能性的影响可能会影响治疗方式和随访。
