Cartilage Cap in Scaphoid Nonunions: An Indication of Stability and Biology?

IF 2.1 2区 医学 Q2 ORTHOPEDICS
Frank Vazquez, Joanne Y Zhou, Kier M Blevins, Musab Gulzar, Constance Sullivan, Nina Suh, Michael B Gottschalk, Eric R Wagner
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引用次数: 0

Abstract

Purpose: Scaphoid nonunion management is controversial and is dependent upon many factors without a clear algorithm. Traditionally, open approaches involved corticocancellous, vascularized, or nonvascularized structural bone grafting with internal fixation. Recent arthroscopic techniques have improved the ability to assess the stability of fractures and the need for bone grafting while preserving blood supply. We present our experience with arthroscopic-assisted scaphoid nonunion repairs that were discovered to have an intact cartilage cap at the nonunion site and thus were treated with screw fixation alone.

Methods: A retrospective review of patients diagnosed with scaphoid nonunion (defined as the lack of union on computed tomography at 6 months postinjury or no change on interval computed tomography scans at least 3 months apart) was performed. Nine patients-noted to have an intact cartilage cap, defined as continuous cartilage as viewed from the midcarpal and radiocarpal portals, without mobility at the fracture site on probing-were included. All underwent percutaneous screw fixation without fracture debridement. Time to union, range of motion, and patient-reported outcome measures were collected retrospectively.

Results: Nine patients aged 16-33 years, with a median follow-up of 35 months (range: 2-74), were included. The mean radiographic displacement was 2 mm, and no fractures had a humpback deformity or dorsal intercalated segmental instability. There was a 100% union rate. At the final follow-up, patient-reported outcome measures demonstrated overall improvement across the cohort. No complications were observed.

Conclusions: Scaphoid nonunions with minimal displacement, maintained mechanical malignment of the carpus, and an intact cartilage cap represent a stable pattern that can be treated by restoring mechanical stability. Thus, if a cartilage cap is found to be intact, arthroscopic-assisted percutaneous screw fixation results in bony union, favorable outcomes, with minimal pain and excellent patient-reported outcomes.

Type of study/level of evidence: Therapeutic V.

舟状骨不连的软骨帽:稳定性和生物学指标?
目的:舟骨骨不连的治疗是有争议的,它取决于许多因素,没有一个明确的算法。传统的开放入路包括皮质松质骨、血管化骨或非血管化骨移植及内固定。最近的关节镜技术提高了评估骨折稳定性的能力和在保留血液供应的情况下进行骨移植的需要。我们介绍了我们在关节镜辅助下舟骨骨不愈合修复的经验,这些不愈合部位发现有完整的软骨帽,因此仅用螺钉固定治疗。方法:回顾性分析诊断为舟状骨不连(定义为损伤后6个月计算机断层扫描未愈合或间隔至少3个月计算机断层扫描未改变)的患者。9例患者均有完整的软骨帽,定义为从腕中部和桡腕门处观察到的连续软骨,在骨折部位无活动。所有患者均行经皮螺钉固定,骨折未清创。回顾性收集愈合时间、活动范围和患者报告的结果测量。结果:纳入9例患者,年龄16-33岁,中位随访35个月(范围:2-74)。平均x线位移为2mm,没有骨折出现驼背畸形或背侧插入节段不稳定。工会率是100%。在最后的随访中,患者报告的结果测量显示整个队列的整体改善。无并发症发生。结论:小位移的舟状骨不连、维持的腕骨机械恶性肿瘤和完整的软骨帽代表了一种稳定的模式,可以通过恢复机械稳定性来治疗。因此,如果发现软骨帽完好无损,关节镜辅助下经皮螺钉固定可实现骨愈合,结果良好,疼痛最小,患者报告的结果也很好。研究类型/证据水平:治疗性V。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.20
自引率
10.50%
发文量
402
审稿时长
12 weeks
期刊介绍: The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.
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