Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia; Department of Orthopedic Surgery, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia; Department of Orthopedic Surgery, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands.
J Hand Surg Am. 2021 Aug;46(8):685-694. doi: 10.1016/j.jhsa.2021.03.027. Epub 2021 May 26.
The decision to continue immobilization of a nondisplaced scaphoid waist fracture is often based on radiographic appearance (despite evidence that radiographs are unreliable and inaccurate for diagnosing scaphoid union 6-12 weeks after fracture) and fracture tenderness (even though it is influenced by cognitive biases on pain). This may result in unhelpful additional immobilization. We studied nondisplaced scaphoid waist fractures to determine the factors associated with (1) the surgeon's decision to continue cast or splint immobilization at the first visit when cast removal was being considered; (2) greater pain on examination; and (3) the surgeon's concern about radiographic consolidation.
We prospectively included 46 patients with a nondisplaced scaphoid waist fracture treated nonoperatively. At the first visit when cast removal was considered - after an average of 6 weeks of immobilization - patients rated pain during 4 examination maneuvers. The treating surgeon assessed union on radiographs and decided whether to continue or discontinue immobilization. Patients completed measures of the following: (1) the degree to which pain limits activities (Patient-Reported Outcome Measure Interactive System [PROMIS] Pain Interference Computer Adaptive Test [CAT], Pain Self-Efficacy Questionnaire-2); (2) symptoms of depression (PROMIS Depression CAT); and (3) upper extremity function (PROMIS Upper Extremity Function CAT). We used multivariable regression analysis to investigate the factors associated with each outcome.
Perceived inadequate radiographic healing and greater symptoms of depression were independently associated with continued immobilization. Pain during the examination was not associated with continued immobilization. Patient age was associated with pain on examination. Shorter immobilization duration was the only factor associated with the surgeon's perception of inadequate radiographic consolidation.
Inadequate radiographic healing and greater symptoms of depression are associated with a surgeon's decision to continue cast or splint immobilization of a nondisplaced scaphoid waist fracture.
Overreliance on radiographs and inadequate accounting for psychological distress may hinder the adoption of shorter immobilization times for nondisplaced waist fractures.
对于无移位的舟状骨腰部骨折，是否继续进行固定的决定通常基于影像学表现（尽管有证据表明，在骨折后 6-12 周，射线照相对于诊断舟骨愈合既不可靠也不准确）和骨折压痛（尽管它受到疼痛认知偏差的影响）。这可能导致不必要的额外固定。我们研究了无移位的舟状骨腰部骨折，以确定与以下因素相关的因素：（1）当考虑拆除石膏时，外科医生决定继续用石膏或夹板固定的情况；（2）检查时疼痛更大；（3）外科医生对影像学愈合的关注。
我们前瞻性纳入了 46 例接受非手术治疗的无移位的舟状骨腰部骨折患者。在考虑拆除石膏的首次就诊时（平均固定 6 周后），患者对 4 种检查操作过程中的疼痛进行了评分。主治医生根据影像学评估骨折愈合情况，并决定是否继续或停止固定。患者完成了以下措施的评估：（1）疼痛对活动的限制程度（患者报告的结局测量信息系统[PROMIS]疼痛干扰计算机自适应测试[CAT]，疼痛自我效能问卷-2）；（2）抑郁症状（PROMIS 抑郁 CAT）；（3）上肢功能（PROMIS 上肢功能 CAT）。我们使用多变量回归分析来研究与每个结果相关的因素。
影像学愈合不足和抑郁症状加重与继续固定独立相关。检查时的疼痛与继续固定无关。患者年龄与检查时的疼痛有关。较短的固定时间是外科医生认为影像学愈合不足的唯一相关因素。
影像学愈合不足和抑郁症状加重与外科医生决定继续对无移位的舟状骨腰部骨折进行石膏或夹板固定有关。
过度依赖射线照相和对心理困扰的评估不足可能会阻碍采用更短的固定时间治疗无移位的腰部骨折。
