From the Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC (Li), and the Department of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN (Dennison, Shin, and Pulos).
J Am Acad Orthop Surg. 2023 Aug 1;31(15):e550-e560. doi: 10.5435/JAAOS-D-22-01210. Epub 2023 Jun 16.
The scaphoid is the most commonly fractured carpal bone. With high clinical suspicion and negative radiographs, expedient evaluation by CT or MRI has been recommended. When treating nondisplaced or minimally displaced scaphoid waist and distal pole fractures, immobilization below the elbow without inclusion of the thumb is an option. Comparatively, early surgical intervention for nondisplaced or minimally displaced scaphoid waist fractures allows for quicker return of function, but with increased risk of surgical complications and no long-term outcomes differences compared with cast immobilization. For most patients with such fractures, consideration for aggressive conservative treatment involving 6 weeks of immobilization with CT assessment to guide the need for continued casting, surgical intervention, or mobilization is advocated. Determination of union is best done with a CT scan at 6 weeks and at least 50% continuous trabecular bridging across the fracture site deemed sufficient to begin mobilization. Nonsurgical and surgical management of scaphoid fractures requires a thorough understanding of fracture location, fracture characteristics, and patient-specific factors to provide the best healing opportunity of this notoriously difficult fracture and return the patient to full function.
手舟骨是最常见的腕骨骨折。临床高度怀疑且 X 线检查阴性时，建议行 CT 或 MRI 迅速评估。治疗无移位或轻度移位的手舟骨腰部和远极骨折时，不包括拇指的肘下固定是一种选择。相比之下，早期手术干预无移位或轻度移位的手舟骨腰部骨折可更快恢复功能，但与石膏固定相比，手术并发症风险增加，且无长期结果差异。对于大多数此类骨折患者，考虑采用积极的保守治疗，包括 6 周的 CT 评估指导持续石膏固定、手术干预或活动的必要性，是提倡的。6 周时进行 CT 扫描和至少 50%连续的骨折部位小梁桥接被认为足以开始活动，是确定愈合的最佳方法。手舟骨骨折的非手术和手术治疗需要对手骨折的位置、骨折特征和患者特定因素有透彻的了解，以提供这个棘手骨折愈合的最佳机会，并使患者恢复完全功能。
