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Zhao H, Tian S, Kong L, Bai J, Lu J, Zhang B, Tian D. Factors associated with union time of acute middle-third scaphoid fractures: an observational study. Ther Clin Risk Manag 2018; 14:1127-1131. [PMID: 29950849 PMCID: PMC6016271 DOI: 10.2147/tcrm.s169310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to investigate the union time of acute middle-third scaphoid fractures following treatments and to analyze the effect of different factors on late union. Patients and methods We retrospectively reviewed patients with acute middle-third scaphoid fracture at our institution between January 2013 and December 2017. Patient demographics, fracture characteristics, and treatment strategy, such as age, gender, body mass index, habit of smoking, sides of injury, dominant hand, ulnar variance, multiple fractures, and treatment methods, were investigated. Univariate and multivariate analyses were used to identify possible predictive factors. Results A total of 132 patients with scaphoid fracture were included in our study. Operation was performed in 67 patients (50.8%), and conservative treatment was performed in the other 65 patients (49.2%). The union time was 7.2±0.5 weeks. In the multivariate logistic regression analysis, late diagnosis (odds ratio, 1.247; 95% CI, 1.022–1.521) and conservative treatment method (odds ratio, 1.615; 95% CI, 1.031–2.528) were identified as 2 independent predictors of late union in scaphoid fractures patients. Other parameters were not demonstrated to be predictive factors. Conclusion Late diagnosis and conservative treatment were two factors associated with late union. Long time of follow-up is necessary for patient with these factors.
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Affiliation(s)
- Hongfang Zhao
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Siyu Tian
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Jiangbo Bai
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Jian Lu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Bing Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Dehu Tian
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, People's Republic of China
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Oka K, Moritomo H. Current Management of Scaphoid Nonunion Based on the Biomechanical Study. J Wrist Surg 2018; 7:94-100. [PMID: 29576913 PMCID: PMC5864502 DOI: 10.1055/s-0038-1637739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
Scaphoid nonunion causes abnormal wrist kinematics and typically leads to carpal collapse and subsequent degenerative arthritis of the wrist. However, the natural history, including carpal collapse and degenerative arthritis of scaphoid nonunion, may vary at different fracture locations. This article reviews recent biomechanical studies related to the natural history of scaphoid nonunion. In the distal-type fractures (type B2 in Herbert classification), where the fracture located distal to the scaphoid apex, the proximal scaphoid fragment and lunate, which are connected through the dorsal scapholunate interosseous ligament (DSLIL) and dorsal intercarpal ligament (DIC), extend together, and the distal fragment of the scaphoid flexes individually. Therefore, untreated type B2 fractures normally show the humpback deformity, resulting in dorsal intercalated segment instability deformity relatively earlier after the injury. In the proximal-type fractures (type B1), where the fracture is located proximal to the scaphoid apex, the connection between the distal fragment and lunate is preserved through the DSLIL and DIC so that the scaphoid-lunate complex remains stable and the carpal collapse is less severe than that in distal-type fractures. The fracture location relative to the apex of the dorsal scaphoid ridge is a reliable landmark in the determination of the natural history of scaphoid nonunion.
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Affiliation(s)
- Kunihiro Oka
- Health and Counseling Center, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka, Japan
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Oura K, Moritomo H, Kataoka T, Oka K, Murase T, Sugamoto K, Yoshikawa H. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion. J Orthop Sci 2017; 22:50-55. [PMID: 27589915 DOI: 10.1016/j.jos.2016.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 04/28/2016] [Accepted: 08/10/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns. METHODS Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients' with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n = 6); distal intra-articular (n = 5); and proximal (n = 6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined. RESULTS The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type. CONCLUSION The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion.
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Affiliation(s)
- Keiichiro Oura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, 1-1-41 Sojiji, Ibaraki-shi, Osaka 567-0801, Japan.
| | - Toshiyuki Kataoka
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, 4-8-1 Hoshiga-oka, Hirakata, Osaka 573-8511, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Ten Berg PW, Drijkoningen T, Strackee SD, Buijze GA. Classifications of Acute Scaphoid Fractures: A Systematic Literature Review. J Wrist Surg 2016; 5:152-159. [PMID: 27104083 PMCID: PMC4838473 DOI: 10.1055/s-0036-1571280] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 01/02/2023]
Abstract
Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes. The intention was to improve data comparison between studies using heterogeneous fracture descriptions. Methods We performed a systematic review of the literature based on a search of medical literature from 1950 to 2015, and a manual search using the reference lists in relevant book chapters. Only original descriptions of classifications of acute scaphoid fractures in adults were included. Popularity was based on citation index as reported in the databases of Web of Science (WoS) and Google Scholar. Articles that were cited <10 times in WoS were excluded. Results Our literature search resulted in 308 potentially eligible descriptive reports of which 12 reports met the inclusion criteria. We distinguished 13 different (sub) classification systems based on (1) fracture location, (2) fracture plane orientation, and (3) fracture stability/displacement. Based on citations numbers, the Herbert classification was most popular, followed by the Russe and Mayo classifications. All classification systems were based on plain radiography. Conclusions Most classification systems were based on fracture location, displacement, or stability. Based on the controversy and limited reliability of current classification systems, suggested research areas for an updated classification include three-dimensional fracture pattern etiology and fracture fragment mobility assessed by dynamic imaging.
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Affiliation(s)
- Paul W. Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa Drijkoningen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simon D. Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert A. Buijze
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tada K, Ikeda K, Okamoto S, Hachinota A, Yamamoto D, Tsuchiya H. Scaphoid Fracture - Overview and Conservative Treatment. ACTA ACUST UNITED AC 2015; 20:204-9. [DOI: 10.1142/s0218810415400018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Scaphoid fracture is the most common fracture in carpal bones. Although the reported union rate of conservatively-treated fractures is more than 90%, there is a controversy over the most appropriate treatment. In recent years, many reports have compared the clinical outcomes of conservatively-treated scaphoid fractures with the results of operatively treated ones using randomized controlled trials and meta-analyses. However, there is no consensus regarding the optimal treatment. In this paper, based on literature review, we provide an overview of the management of the acute scaphoid fractures particularly focusing on the issues related to conservative treatment.
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Affiliation(s)
- Kaoru Tada
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Kazuo Ikeda
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Shunro Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ai Hachinota
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Daiki Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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