Bk Dinesh Kumar, Lamichhane Pratik, Pandit Pukar, Thapa Kishor
Department of Orthopedics,GP Koirala National Center for Respiratory Diseases, Tanahun, Nepaland Department of General Medicine and Surgery, GP Koirala National Center for Respiratory Diseases, Tanahun, Nepal.
Ann Med Surg (Lond). 2025 May 12;87(6):3076-3081. doi: 10.1097/MS9.0000000000003342. eCollection 2025 Jun.
Non-union scaphoid fractures are a hazard to the wrist because of the increasing risk of avascular necrosis and degenerative changes. We managed non-union scaphoid fractures by open reduction, Kirschner (K)-wire fixation, and bone graft from distal radius.
This retrospective case series included seven patients with missed, established cases of non-union scaphoid fractures diagnosed by imaging at a tertiary care center between 2015 and 2017 in Nepal. All patients were treated with open reduction, K-wire fixation, and ipsilateral distal radius bone grafting. The patients were followed up at one, two, three, six and eight month post-surgery with imaging and at six and eight months with the modified Mayo wrist score (MMWS).
The mean duration of treatment time after the primary injury was 7 months. All the cases were males and the mean age of patients at surgery was 27 (range = 17-46) years. The mean duration of radiological and clinical evidence of healing was 4.3 months. The radiological healing was confirmed in all treated patients. All of the patients had improved outcomes in wrist function as indicated by improvement in MMWS at six and eight months.
Our case series showed that the standard method using open reduction, K-wire fixation, and ipsilateral distal radius bone grafting is a reliable and cost-effective procedure for most untreated and non-union scaphoid fractures.
舟骨骨折不愈合对腕关节构成危害，因为缺血性坏死和退行性变的风险不断增加。我们采用切开复位、克氏针固定及取自桡骨远端的骨移植来治疗舟骨骨折不愈合。
本回顾性病例系列纳入了2015年至2017年在尼泊尔一家三级医疗中心经影像学诊断为漏诊、确诊的舟骨骨折不愈合的7例患者。所有患者均接受切开复位、克氏针固定及同侧桡骨远端骨移植治疗。术后1个月、2个月、3个月、6个月和8个月对患者进行影像学随访，并在6个月和8个月时采用改良梅奥腕关节评分（MMWS）进行评估。
初次受伤后平均治疗时间为7个月。所有病例均为男性，手术时患者的平均年龄为27岁（范围=17 - 46岁）。影像学和临床愈合证据的平均持续时间为4.3个月。所有接受治疗的患者均获得影像学愈合。6个月和8个月时MMWS改善表明所有患者的腕关节功能均有改善。
我们的病例系列表明，对于大多数未经治疗的舟骨骨折不愈合，采用切开复位、克氏针固定及同侧桡骨远端骨移植的标准方法是一种可靠且具有成本效益的手术。
