橈骨舟状骨偽関節手術後のプレート除去が機能および患者報告アウトカムに及ぼす影響

Volar locking plate fixation with cancellous bone grafting is an effective treatment for scaphoid non-union. However, the plate can impinge on the volar rim of the radius, causing pain or restricted movement that often necessitates plate removal. The primary aim of this study was to evaluate the effect of hardware removal on wrist function and patient-reported outcomes after plate fixation for scaphoid non-union.

This prospective study assessed 49 of 113 patients who underwent plate fixation for scaphoid non-union and later required plate removal due to functional impairment. Range of flexion and extension, grip strength and Patient-Rated Wrist and Hand Evaluation (PRWHE) scores were measured before non-union surgery, after bone union but before plate removal, and at 3 months after plate removal.

A decrease in wrist flexion after the initial non-union surgery (60-48°) was reversed by plate removal (48-65°). Extension and grip strength increased significantly compared with pre-operative values (54-65° and 66-88%). Patient-reported outcomes also showed marked improvement, with PRWHE scores improving from 36 preoperatively to 23 after union, and finally to 4 after plate removal. No complications related to plate removal were observed.

Plate removal in patients with functional impairment after scaphoid non-union surgery produces clinically meaningful improvements in wrist movement and patient-reported outcomes.

Level III.