[Reconstructive surgical procedures in scaphoid pseudarthrosis]

Operative procedures for application in scaphoid nonunion are limited by secondary changes of wrist and carpus. The choice of treatment is determined by the degree of vascularization of the fragments. Bony union can be achieved by means of an autogenous free bone graft if there is adequate vascularization of at least one fragment. In the case of extensive impairment of the blood supply, a bone graft on a vascular pedicle is recommended. The postoperative stability of the fragments is of decisive importance for consolidation of the nonunion. The localization and orientation of the nonunion and the extent to which the blood supply is impaired determine the choice of treatment. The standard methods of operation are demonstrated. Our results and experience with the techniques of Matti-Russe I (86 cases), Russe II (18 cases), the Pechlaner-Hussl vascular pedicle bone transplant (35 cases) and the Herbert screw (18 cases) are reported.