Abstract：
BACKGROUND: Non-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce. This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique.
METHODS: Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength.
RESULTS: Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE.
CONCLUSIONS: The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.
METHODS: Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength.
RESULTS: Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE.
CONCLUSIONS: The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.
摘要：
背景：骨不连是舟骨骨折的常见并发症。晚期诊断很常见，并且由于患者的功能限制而具有临床影响。已经提出了多种治疗方法来管理这种并发症，范围从保守(即，骨科)到手术治疗。血管化股骨内侧髁技术显示了满意的临床和临床效果。主要存在近端极无血管坏死，但有关功能结局和患者满意度的数据很少。本病例系列旨在描述连续一系列接受血管化股骨内侧髁技术治疗的舟骨近端三分之一不愈合患者的临床和患者报告结果。
方法：病例系列报告连续初始队列患者的结果，这些患者表现为舟骨近端骨折，所有患者术前通过CT和MRI成像记录了近端极的缺血性坏死。测量工具包括q-DASH和PRWE问卷，射线照相图像，测角,并评估握力。
结果：包括12例连续患者，它们代表了所有涉及的外科医生的初始病例；平均随访时间为31个月（6-72）后，10例患者（83％）获得了骨愈合，记录了运动范围和握力的成功改善.患者的满意度很高，Q-DASH平均得分为17.3分，PRWE平均得分为20.1分。
结论：在舟骨骨折骨不连的情况下，血管化内侧髁技术在临床上是一种可重复的治疗方法，在成像和功能方面，以及患者满意度。对于专门的多外科医生团队来说，学习曲线是平坦的。
方法：病例系列报告连续初始队列患者的结果，这些患者表现为舟骨近端骨折，所有患者术前通过CT和MRI成像记录了近端极的缺血性坏死。测量工具包括q-DASH和PRWE问卷，射线照相图像，测角,并评估握力。
结果：包括12例连续患者，它们代表了所有涉及的外科医生的初始病例；平均随访时间为31个月（6-72）后，10例患者（83％）获得了骨愈合，记录了运动范围和握力的成功改善.患者的满意度很高，Q-DASH平均得分为17.3分，PRWE平均得分为20.1分。
结论：在舟骨骨折骨不连的情况下，血管化内侧髁技术在临床上是一种可重复的治疗方法，在成像和功能方面，以及患者满意度。对于专门的多外科医生团队来说，学习曲线是平坦的。
