[Non-union in os scaphoideum and its surgical treatment: overview of literature]

Authors present an overview of surgical methods used for the treatment of os scaphoideum with a focus on currently most frequent operations. In the period between January 1998 and March 2004, the authors performed 100 operations on the scaphoid bone, of this 54times primary fixation and 46times surgery for non-union in 42 patients. The most frequent method was resection of non-union, implantation of tri-cortical bone graft and internal fixation (17times). This method is considered by the authors optimal in non-unions in the middle third of the bone without signs of avascular necrosis of the roximal pole. In 8 patients with signs of avascular necrosis of the proximal pole and in non-unions in the proximal third, reconstruction was done by vascularized bone graft after Zaidemberg. In case of the finding of a minimal sclerotic line without deformation or shortening of the bone the method of choice was compression of the non-union by a screw (Herbert screw, HBS, Synthes screw) in 8 patients. Intramedullary cancellous bone graft and internal fixation was used in 8 patients. However, the authors do not consider it as an optimal treatment as it does not guarantee preservation of the length of the bone until the healing of the non-union. This surgery was used by the authors only as an alternative when it was not possible to choose another method. Extirpation of the distal scaphoid bone (twice) and proximal carpectomy (twice, of this once together with the dennervation after Wilhelm) were performed in non-unions with marked osteoarthritic changes of the radiocarpal joint. In one patient the proximal pole was excised and replaced by tendon graft. The authors do not have experience in limited intercarpal arthrodesis, but most other authors currently prefer proximal carpectomy to this technically demanding operation.