Shoji Kristin E, Simeone F Joseph, Ozkan Sezai, Mudgal Chaitanya S
Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, Massachusetts.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Wrist Surg. 2020 Jun;9(3):203-208. doi: 10.1055/s-0040-1701512. Epub 2020 Feb 10.
Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of "proximal pole scaphoid fractures" who underwent surgical fixation by a single surgeon over an 11-year period (2006-2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm . Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8-16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. This is a Level IV, case series study.
舟状骨近端骨折因其血供薄弱，不愈合风险增加。舟状骨近端骨折不愈合的最佳治疗方法仍存在争议。 回顾一位外科医生对舟状骨近端新鲜不愈合（延迟愈合）和不愈合患者的治疗经验，这些患者接受了空心无头加压螺钉内固定及取自桡骨远端的局部自体骨移植。 在获得机构审查委员会批准后，查询了一家三级医疗中心的电子病历，以找出在11年期间（2006 - 2017年）由同一位外科医生进行手术固定的诊断为“舟状骨近端骨折”的患者。15名患者符合初始查询标准；经病历审查，4名患者因骨折为急性而被排除，1名患者因手术固定包括带血管蒂骨移植而被排除。 最终研究队列由10名患者组成，共有10例舟状骨近端骨折不愈合。本研究中几乎所有患者为男性（9/10 [90%]），体育活动是最常见的受伤机制（8/10 [80%]）。计算机断层扫描（CT）对舟状骨骨折的容积测量显示，舟状骨的平均总体积为2.4±0.48 cm ，近端骨折块的平均体积为0.38±0.15 cm 。术后CT扫描平均在12.4周（范围：8 - 16周）进行，7例（7/10 [70%]）显示完全愈合迹象，3例（3/10 [30%]）显示部分愈合。所有患者均无需额外手术，且无并发症发生。 我们的结果表明，采用手术固定和自体局部骨移植治疗的舟状骨近端骨折延迟愈合和不愈合患者无需更复杂的带血管蒂手术即可愈合。近端骨折块的体积与初次手术后持续不愈合风险增加无关。 这是一项IV级病例系列研究。
