Dy Christopher J, Kazmers Nikolas H, Baty Jack, Bommarito Kerry, Osei Daniel A
1Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO USA.
2Department of Orthopaedics, University of Utah, Salt Lake City, UT USA.
HSS J. 2018 Oct;14(3):245-250. doi: 10.1007/s11420-018-9619-3. Epub 2018 Jun 4.
Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion.
QUESTIONS/PURPOSES: We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time.
The MarketScan database was queried for all records of treatment (casting and surgery) for closed scaphoid fractures over a 6-year period. We examined subsequent claims to determine frequency of additional procedures for nonunion treatment (revision fixation or vascularized grafting occurring 28 days or more after initial treatment). Trend analyses were used to determine whether changes in frequency of surgical treatment or revision procedure occurred.
The estimated incidence density of scaphoid fracture is 10.6 per 100,000 person-years in a commercially insured population of less than 65 years of age. Of 8923 closed scaphoid fractures, 29 and 71% were treated with surgery and casting, respectively. The frequency of surgical treatment rose significantly, from 22.1% in 2006 to 34.1% in 2012. The frequency of nonunion treatment was 10.8% after surgery and 3% after casting; neither changed over time. Younger age, male sex, and surgical treatment are associated with a higher risk of nonunion treatment.
Our estimated incidence of scaphoid fracture is higher than previously reported. The increased enthusiasm in the USA to surgically treat scaphoid fractures is reflected by our trend analysis. The frequency of surgical treatment for presumed nonunion after initial surgical management for closed scaphoid fractures exceeded 10%. Given the increased utilization of surgery, surgeons and patients should be aware of the frequency of nonunion treatment to inform treatment decisions.
舟骨骨折无论采用非手术治疗还是手术治疗，都可能出现骨不连并发症。
问题/目的：我们试图验证主要假设，即舟骨骨折治疗的发病率密度高于先前估计，确定骨不连治疗的频率和风险因素，并确定手术治疗频率是否随时间增加。
查询MarketScan数据库中6年期间闭合性舟骨骨折的所有治疗记录（石膏固定和手术）。我们检查后续索赔，以确定骨不连治疗的额外手术频率（初次治疗28天或更长时间后进行翻修固定或带血管蒂植骨）。采用趋势分析确定手术治疗或翻修手术频率是否发生变化。
在年龄小于65岁的商业保险人群中，舟骨骨折的估计发病率密度为每10万人年10.6例。在8923例闭合性舟骨骨折中，分别有29%和71%接受了手术和石膏固定治疗。手术治疗频率显著上升，从2006年的22.1%升至2012年的34.1%。手术后骨不连治疗频率为10.8%，石膏固定后为3%；两者均未随时间变化。年龄较小、男性和手术治疗与骨不连治疗风险较高相关。
我们估计的舟骨骨折发病率高于先前报道。我们的趋势分析反映出美国对舟骨骨折手术治疗的热情增加。闭合性舟骨骨折初次手术治疗后假定骨不连的手术治疗频率超过10%。鉴于手术使用率增加，外科医生和患者应了解骨不连治疗频率，以便做出治疗决策。
