[The Outcomes of Navicular Fracture Surgery].

IF 0.4 4区 医学 Q4 ORTHOPEDICS
Marek Peml, Karel Holub, Martin Pompach, Michal Pešta, Pavel Dráč, Martin Kloub
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引用次数: 0

Abstract

Purpose of study: Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures.

Material and method: Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs.

Results: Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21-67) years, with mean follow-up duration of 68 (18-130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital.

Discussion: Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries.

Conclusion: Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.

[舟骨骨折手术的结果]。
研究目的:对舟骨移位性骨折治疗不当可能导致错位,形成骨不连,加速骨关节炎或缺血性坏死的发展,从而从根本上限制活动能力和步态障碍。我们研究的目的是评估我们组接受舟骨骨折手术的患者的结果。材料和方法:我们的回顾性单中心研究纳入了2009年至2018年在我科接受手术治疗的所有18岁以上舟骨骨折患者。共有18名患者符合这些标准,并被邀请进行临床和放射随访。一名患者拒绝出席,两名患者失去了随访。其余15例患者进行临床评估,包括使用AOFAS中足和VAS评分,并通过x线片确定骨关节炎的等级。结果:我们的最后一组患者包括6名女性和9名男性。患者手术时平均年龄为43(21-67)岁,平均随访时间为68(18-130)个月。最常见的创伤机制是高能损伤,发生在9例中。根据Schmid分类,6例为I型和II型骨折,3例为III型骨折。6例伴有足部和踝关节损伤。所有骨折愈合。14例行切开复位内固定(ORIF)。x线片显示9例患者存在0级或I级骨关节炎,6例患者存在II级和III级骨关节炎。AOFAS中足量表优、良11例,满意2例,差2例。平均AOFAS中足评分为87.7分。一个手术相关的并发症是一例皮肤坏死的病人最终在另一家医院接受腔突椎骨关节融合术。讨论:与文献数据一致,我们组显示足部伴随损伤的发生率较高。使用两种入路与发生无血管性坏死的风险增加无关。虽然我们确实将克氏针作为分期治疗的一部分或作为一种额外的固定方式,但我们不推荐使用克氏针进行最终的骨固定。与其他作者一样,我们观察到,在损伤更严重的患者亚组中,创伤后骨关节炎的等级更高。结论:大多数舟状骨骨折移位患者的开放性复位和稳定的骨融合术具有良好的预后。这些骨折最严重的后果是创伤后关节炎和疼痛。寻找伴随损伤是至关重要的。鉴于这些骨折罕见,最好在专门的医疗中心进行治疗。
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来源期刊
CiteScore
0.70
自引率
25.00%
发文量
53
期刊介绍: Editorial Board accepts for publication articles, reports from congresses, fellowships, book reviews, reports concerning activities of orthopaedic and other relating specialised societies, reports on anniversaries of outstanding personalities in orthopaedics and announcements of congresses and symposia being prepared. Articles include original papers, case reports and current concepts reviews and recently also instructional lectures.
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