Stanford University, Redwood City, CA, USA.
Duke University, Durham, NC, USA.
Hand (N Y). 2023 Mar;18(2_suppl):38S-45S. doi: 10.1177/15589447211038678. Epub 2021 Sep 5.
Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters.
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient-reported outcome measures. Study quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive summaries of the studies are presented.
The initial search yielded 1600 articles. Ten articles (161 participants, 93% males, mean age = 28.3 + 6.3 years, mean MINORS score = 10.2 + 1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45° (3 articles), LISA >35° (1 article), and height to length ratio >0.6 (3 articles). Four out of 5 studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging.
There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intrarater and interrater reliabilities for all reported imaging measurements, and utilize validated patient-reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.
骨折后腕舟骨排列异常被用作固定的指征。腕舟骨骨折复位和固定后可接受的排列尚未明确定义。我们系统地回顾了文献，以确定目前如何定义和通过哪些参数来定义舟骨畸形愈合。
使用系统评价和荟萃分析的首选报告项目指南进行系统评价。搜索了多个英文数据库，以查找报告舟骨畸形愈合后结果并包括定义畸形愈合的测量值的研究。收集了影像学舟骨测量参数。记录的临床结果测量包括握力、腕关节活动范围和患者报告的结果测量。使用非随机研究方法学指数 (MINORS) 标准分析研究质量。给出了研究的描述性总结。
最初的搜索产生了 1600 篇文章。纳入并分析了 10 篇文章（161 名参与者，93%为男性，平均年龄 = 28.3 + 6.3 岁，平均 MINORS 评分为 10.2 + 1.6）。如果侧腕舟骨角（LISA）>45°（3 篇文章）、LISA>35°（1 篇文章）和高度与长度比>0.6（3 篇文章），则定义为舟骨畸形愈合。4 项研究中的 5 项研究发现影像学上测量的舟骨畸形愈合程度与患者结果之间没有显著相关性。
目前在影像学上定义舟骨畸形愈合缺乏共识，影像学表现与患者结果之间缺乏相关性。未来定义舟骨畸形愈合的研究应具有适当的效力，纳入所有报告影像学测量的内部和内部可靠性测量，并使用经过验证的患者报告结果测量来反映畸形愈合与对患者有意义的较差结果相关。
