Schreiber Joseph J, Kang Lana, Hearns Krystle A, Pickar Tracy, Carlson Michelle G
Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
J Wrist Surg. 2018 Sep;7(4):319-323. doi: 10.1055/s-0038-1660445. Epub 2018 Jun 8.
Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity. The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm. Patients with proximal pole scaphoid fragments comprising less than 20% of the entire scaphoid were included. Fixation was accomplished from a dorsal approach with a micro headless compression screw and distal radius bone graft. Six patients were included. Average follow-up was 44 months (range, 11-92). Mean proximal pole fragment size was 14% (range, 9-18%) of the entire scaphoid. The mean immobilization time was 6 weeks, time-to-union of 6 weeks, and final flexion/extension arc of 88°/87°. All patients had a successful union, and no patient had deterioration in range of motion, avascular necrosis, or fragmentation of the proximal pole. Small diameter screws with a maximal thread diameter of ≤ 2.8 mm can be used to fix the union of proximal pole acute scaphoid fractures comprising less than 20% of the total area with good success. Therapeutic case series, Level IV.
由于骨折块大小和血运薄弱，实现小的近端舟骨急性骨折的充分固定和愈合在手术上具有挑战性。本研究的目的是证明，使用一种“微型”小直径加压螺钉并结合桡骨远端植骨，其前后螺纹直径小于2.8毫米，可成功治疗此类损伤。纳入近端舟骨骨折块占整个舟骨不到20%的患者。采用微型无头加压螺钉经背侧入路并结合桡骨远端植骨进行固定。共纳入6例患者。平均随访44个月（范围11 - 92个月）。近端舟骨骨折块平均大小为整个舟骨的14%（范围9% - 18%）。平均固定时间为6周，愈合时间为6周，最终屈伸弧度为88°/87°。所有患者均成功愈合，且无患者出现活动范围恶化、缺血性坏死或近端骨折块碎裂。最大螺纹直径≤2.8毫米的小直径螺钉可用于固定占总面积不到20%的近端舟骨急性骨折的愈合，成功率较高。治疗性病例系列，IV级。
