[Pseudarthrosis of the scaphoid]

For the treatment of scaphoid non-unions, innumerable curative and palliative operations have been recommended. Of the curative operations, the various methods of bone grafting give the best results, whereas screw fixation is not satisfactory. Bone pegs with a cortical graft are no longer used because of technical difficulties. Corticocancellous grafts (Matti-Russe) yield bony union in almost 90% of cases. The combination of corticocancellous grafts with plate stabilization gives the highest rate of bony union (99%). A cure should therefore always be attempted in all non-union cases, with the exception of cases already involving severe, generalized osteoarthritis or extensive necrosis of the scaphoid. Of the different palliative methods, the early results of prosthetic partial or total replacement of the scaphoid are satisfactory. Late results are less satisfactory, with a high rate of complications and carpal collapse. With severe osteoarthrosis, proximal carpectomy, especially the transscaphoideo-lunate resection, gives good results. Intercarpal arthrodeses have been disappointing. Radiocarpal arthrodesis results in a pain-free, strong wrist; however, there is complete loss of motion, whereas denervation gives satisfactory results in 57% and preserved mobility of the wrist.