Prabhakar Pooja, Wessel Lauren, Nguyen Joseph, Stepan Jeffrey, Carlson Michelle, Fufa Duretti
Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas.
Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
J Wrist Surg. 2020 Apr;9(2):141-149. doi: 10.1055/s-0039-3402769. Epub 2020 Jan 20.
Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. We performed a retrospective case-control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. This is a Level III, therapeutic study.
舟骨骨折切开复位内固定术（ORIF）后骨不连的发生率在5%至30%之间；然而，骨不连的预测因素尚未明确界定。 本研究的目的是确定可能影响舟骨骨折切开复位内固定术后骨不连进展的骨折特征和手术因素。 我们对2003年至2017年间接受早期切开复位内固定术治疗的舟骨骨折患者进行了一项回顾性病例对照研究。纳入标准为受伤后6个月内进行手术固定，术后行CT检查，临床随访至少6个月以评估愈合情况。本研究共纳入48例患者。骨不连病例按年龄、性别和骨折部位与骨折愈合的患者以1:2的比例进行匹配。 这组48例患者中，16例骨不连病例与32例骨折愈合病例相匹配。骨折部位近端极占15%（7/48），腰部占85%（41/48）。多因素回归分析表明，受伤至初次切开复位内固定术的时间较短以及近端骨折块体积百分比越小，与切开复位内固定术后舟骨骨不连显著相关（分别为63天对27天和34%对40%）。受试者工作特征曲线分析显示，骨折体积低于38%以及受伤至手术时间大于31天与骨不连相关。 当骨折在受伤后31天以上进行治疗且骨折体积小于整个舟骨的38%时，骨不连的可能性增加。 这是一项III级治疗性研究。
