Bezirkskrankenhaus Schwaz Betriebsgesellschaft mbH, Swarovskistraße 1-3, 6130, Schwaz, Austria.
Universitätsklinikum St. Pölten, Matthias-Corvinus Straße 45, 3100, St. Pölten, Austria.
J Orthop Traumatol. 2023 Feb 10;24(1):6. doi: 10.1186/s10195-023-00686-7.
Allograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union.
We retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union.
Using the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94-96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate.
Using the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures-but better union rates in pseudarthrosis patients-compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars.
III: retrospective cohort study, therapeutic investigation of a treatment.
同种异体骨螺钉很少用于舟骨固定。当治疗新鲜骨折时，主要使用金属螺钉；当出现假关节时，主要使用带血管或不带血管的骨移植的钢板。对于金属螺钉是否需要取出存在争议，但对于钢板来说是强制性的，因为钢板会限制运动。生物材料在舟骨骨折固定中的应用被描述为可使愈合率达到 64%至 100%。Bricic 术后 10 周显示，同种异体皮质骨螺钉的植入，伴随着再血管化和稳定的骨愈合，没有任何免疫排斥的迹象。本回顾性研究的目的是探讨同种异体皮质骨螺钉（Shark Screw®）在新鲜舟骨骨折固定和假关节患者中的应用，以评估愈合率和愈合时间。
我们回顾性分析了 75 例患者：31 例新鲜骨折患者和 44 例假关节患者。Shark Screw®用于新鲜骨折和假关节患者的舟骨固定。我们评估了愈合率、并发症发生率和愈合时间。
使用同种异体皮质骨螺钉治疗舟骨骨折可获得较高的愈合率（94-96%）。新鲜骨折组有 2 例不愈合，假关节组有 2 例不愈合。并发症发生率为 1.3%（1 例）。新鲜骨折、假关节和延迟愈合患者的愈合时间中位数分别为 16、18 和 29 周。治疗新鲜舟骨骨折和假关节的方法与文献报道的方法相似，具有愈合率高、手术时间短、创伤小、无需去除内固定、并发症发生率低等优点。
使用同种异体皮质骨螺钉（Shark Screw®）治疗新鲜骨折的愈合率与文献报道的其他舟骨骨折固定技术相似，但治疗假关节的愈合率更好，且可进行短期、微创的手术，无供区并发症，无需在二次手术中取出内固定。假关节患者组从这种新方法中获益尤其明显。皮质骨螺钉的生理骨代谢重塑过程没有疤痕。
III：回顾性队列研究，治疗方法的治疗性研究。
