Strelzow Jason A, Snapp W Kelsey, Giladi Aviram M, Wysocki Robert, Jehle Charles C
Department of Orthopaedic Surgery, Washington University, St. Louis, MO.
Baptist Health Medical Group, Lexington, KY.
J Hand Surg Glob Online. 2024 Sep 14;6(6):836-841. doi: 10.1016/j.jhsg.2024.06.013. eCollection 2024 Nov.
The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership's practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management.
Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs. The survey was divided into the following subtopics: minimally displaced scaphoid fracture, operative options for scaphoid fixation, and treatment of scaphoid nonunion.
Of 9 EBP questions, only one was answered with the preferred response by >80% of surgeons. The remaining seven EBP questions had greater frequencies of less preferred responses. These questions concerned the current evidence for initial imaging options, optimal nonsurgical immobilization, percutaneous management, and the identification and treatment of nonunion. Of the PP questions, there were substantial differences of opinion on the choice of bone graft for nonunion, revisions, and patients with avascular necrosis. Nearly unanimous agreement was found for the use of headless compression screws for scaphoid fixation; however, the choice of approach for waist fixation was split between dorsal and volar percutaneous techniques and an open dorsal approach.
Scaphoid fracture and nonunion management continues to be an area of expanding evidence. There remain opportunities for our community to improve knowledge and familiarization with current evidence-based data. Many PPs areas demonstrated substantial agreement among the membership; however, there are areas of differences particularly graft choice, optimal approach for waist fixation, and postfixation protocols. Knowledge and familiarity with peer practices may help develop future areas of research and help to optimize patient care through a critically review and interpretation of the evidence.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/decision analyses V.
美国手外科协会循证实践委员会着手评估其成员对于舟骨骨折及骨不连治疗的实践模式（PPs）以及对循证原则的熟悉程度。
2023年9月，通过电子邮件邀请美国手外科协会的所有成员参与一项由共识生成的包含25个项目的在线调查。使用了两种问题类型，包括循证实践（EBP）和PPs。调查分为以下子主题：无移位舟骨骨折、舟骨固定的手术选择以及舟骨骨不连的治疗。
在9个EBP问题中，只有一个问题超过80%的外科医生给出了首选答案。其余7个EBP问题中，不太理想答案的出现频率更高。这些问题涉及初始影像学检查选择、最佳非手术固定、经皮治疗以及骨不连的识别与治疗的当前证据。在PP问题中，对于骨不连、翻修手术以及缺血性坏死患者的骨移植选择存在很大的意见分歧。对于使用无头加压螺钉固定舟骨，几乎达成了一致意见；然而，腰部固定的手术入路在背侧和掌侧经皮技术以及开放背侧入路之间存在分歧。
舟骨骨折和骨不连的治疗仍然是一个证据不断扩展的领域。我们这个群体仍有机会提高对当前循证数据的认识和熟悉程度。许多PPs领域在成员中达成了实质性共识；然而，存在分歧的领域特别是骨移植选择、腰部固定的最佳入路以及固定后方案。了解和熟悉同行的实践可能有助于开展未来的研究领域，并通过对证据进行批判性审查和解释来优化患者护理。
研究类型/证据级别：经济/决策分析V。
