Naval Medical Center San Diego, CA, USA.
Hand (N Y). 2023 Jan;18(1):122-125. doi: 10.1177/15589447211003177. Epub 2021 Apr 8.
Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion.
We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up.
A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( = .0115).
Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.
舟状骨骨不连可发生于多达 55%的移位性舟状骨骨折。该损伤的长期功能预后情况尚不清楚。此外，尚无研究报道此类损伤后重返现役的比例。我们的目的是教育医务人员和患者了解舟状骨骨不连治疗后的预期功能结果和重返工作岗位的情况。
我们对 2008 年至 2017 年在我院接受舟状骨骨不连修复的患者进行了回顾性研究。主要结局指标为通过电话获得的愈合率、重返现役率和功能结局评分。共纳入 144 例患者，其中 40 例患者对我们的长期随访电话做出了回应。
手术后，共有 72%的患者实现了愈合，18%需要进行翻修手术，74%的患者手术后能够恢复全勤。但在手术后 1、2 和 5 年，这一比例逐渐下降。术后平均 5.9 年，平均 Quick Disabilities of the Arm, Shoulder, and Hand（qDASH）评分为 23.9。愈合患者的 qDASH 平均得分为 21.9，显著低于持续不愈合患者的 29.2（ =.0115）。
舟状骨骨不连在军队中是一个难题。我们发现，常需要翻修为部分或全腕关节融合术来治疗持续不愈合的患者比例很高。此外，我们的长期功能结局评分显示，即使愈合，此类损伤后仍会导致显著的残疾。这些信息可以帮助我们更好地为患者提供咨询，并在治疗此类损伤后设定预期。
