Gupta Mehek, Hui Bernice Heng Qi, Satkunanantham Mala, Yi Lee Tina Munn, Jieying Xu, Teoh Lam-Chuan
Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Singapore.
J Hand Surg Glob Online. 2025 Jan 30;7(2):219-224. doi: 10.1016/j.jhsg.2024.12.007. eCollection 2025 Mar.
We introduce the "Perforate and Fill" technique for bone grafting of scaphoid fracture with delayed union and nonunion, which preserves the cartilage shell and does not break open the fibrous nonunion. This article describes the technique and reports the experience in 11 scaphoid fractures.
The records of 11 patients whose scaphoid fractures were managed surgically with this bone grating technique from our institution from July 2017 to June 2024 were reviewed retrospectively. Patient and fracture factors, radiographic measurements of bone defect, postoperative films, and subjective and objective outcomes were considered.
The radiographic union of the fracture ranges from 36 to 110 days (an average of 68 days). In the last follow-up review, the affected wrists were pain free in all cases, and they were able to resume their premorbid status of vocation and resumed all physical activities. In nine cases, their total wrist motion (including flexion, extension, radial, and ulnar deviation) measured 130° to 195° (an average of 172° and 93% of the opposite wrists). In these nine cases, their grip strengths measured 28-50 kg (an average of 31.5 kg and is 97% of the opposite hand).
In conclusion, in treatment of scaphoid fracture delayed union and nonunion, the "Perforate and Fill" technique of bone grafting is a good alternative to the conventional wedge grafting technique. The advantage of keeping the intact cohesive union of cartilage shell and a less-invasive approach may contribute to the success of the fracture union in our 11 cases using this technique.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们介绍一种用于舟骨骨折延迟愈合和不愈合骨移植的“穿孔填充”技术，该技术保留软骨壳且不打开纤维性不愈合处。本文描述该技术并报告11例舟骨骨折的治疗经验。
回顾性分析2017年7月至2024年6月在本机构采用这种骨移植技术手术治疗的11例舟骨骨折患者的记录。考虑患者和骨折因素、骨缺损的影像学测量、术后X线片以及主观和客观结果。
骨折的影像学愈合时间为36至110天（平均68天）。在最后一次随访复查中，所有病例患腕均无疼痛，且能够恢复病前的职业状态并恢复所有体力活动。9例患者的腕关节总活动度（包括屈伸、桡偏和尺偏）为130°至195°（平均172°，为对侧腕关节的93%）。在这9例患者中，握力为28 - 50千克（平均31.5千克，为对侧手的97%）。
总之，在治疗舟骨骨折延迟愈合和不愈合时，“穿孔填充”骨移植技术是传统楔形移植技术的良好替代方法。在我们使用该技术的11例病例中，保持软骨壳完整的黏合连接以及采用侵入性较小的方法的优势可能有助于骨折愈合成功。
研究类型/证据水平：治疗性IV级。
