Schädel-Höpfner Michael, Windolf Joachim, Lögters Tim, Pillukat Thomas, Jung Martin, Bickert Berthold
Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Lukaskrankenhaus Neuss, Rheinland Klinikum, Preußenstraße 84, 41464, Neuss, Deutschland.
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Unfallchirurgie (Heidelb). 2023 Oct;126(10):799-811. doi: 10.1007/s00113-023-01364-3. Epub 2023 Sep 14.
Scaphoid fractures are by far the most frequent fractures of the carpal bones of the hand and often lead to problematic healing processes if the diagnostics and treatment are inadequate. The main complication of a scaphoid fracture is pseudarthrosis, which leads to carpal collapse and degenerative arthritis of the wrist if left untreated. Early diagnosis and individualized differentiated treatment aim to achieve bony healing with restoration of the scaphoid shape and preservation of the function of the wrist. The anatomical and biomechanical characteristics of the scaphoid can impede bony healing after a fracture and, in contrast to the diagnostics and treatment, cannot be influenced. A history of trauma and typical clinical signs of a scaphoid fracture should lead to systematic imaging diagnostics with obligatory computed tomography. Only by determining the exact fracture morphology can an appropriate treatment concept be established. Conservative treatment should be restricted to stable fractures without relevant displacement. Fractures of the proximal scaphoid pole are considered unstable even if they are not displaced. Operative treatment is indicated for all unstable fractures. The favored surgical procedure is osteosynthesis with a cannulated double-threaded screw, which can be used in a retrograde or antegrade manner and in a minimally invasive or open technique, depending on the fracture type. Surgical treatment results in earlier bony healing and quicker restoration of function but can be associated with a higher complication rate. Posttraumatic osteoarthritis after healing in malalignment is usually asymptomatic.
舟骨骨折是迄今为止手部腕骨中最常见的骨折，如果诊断和治疗不当，常常会导致愈合过程出现问题。舟骨骨折的主要并发症是假关节形成，如果不进行治疗，会导致腕骨塌陷和腕关节退行性关节炎。早期诊断和个体化的差异化治疗旨在实现骨折部位的骨性愈合，恢复舟骨形状，并保留腕关节功能。舟骨的解剖学和生物力学特性可能会妨碍骨折后的骨性愈合，而且与诊断和治疗不同，这些特性无法被改变。有外伤史以及舟骨骨折的典型临床体征时，应进行系统的影像学诊断，必须包括计算机断层扫描。只有确定确切的骨折形态，才能制定合适的治疗方案。保守治疗应仅限于无明显移位的稳定骨折。即使近端舟骨极骨折没有移位，也被认为是不稳定的。所有不稳定骨折均需进行手术治疗。首选的手术方法是使用空心双螺纹螺钉进行骨内固定，根据骨折类型，可采用逆行或顺行方式，以及微创或开放技术。手术治疗可使骨折部位更早实现骨性愈合，功能恢复更快，但可能会有较高的并发症发生率。骨折畸形愈合后的创伤后骨关节炎通常没有症状。
