[Pseudarthrosis of the scaphoid].

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Bone Healing Research

Background:

• Scaphoid non-unions present complex treatment challenges.
• Numerous surgical interventions have been developed for scaphoid non-unions, with varying success rates.

Purpose of the Study:

• To review and compare the efficacy of different surgical treatments for scaphoid non-unions.
• To identify optimal curative and palliative strategies for scaphoid non-union management.

Main Methods:

• Review of curative surgical techniques, including bone grafting and screw fixation.
• Evaluation of palliative procedures such as prosthetic replacement, carpectomy, arthrodesis, and denervation.

Main Results:

• Corticocancellous grafts (Matti-Russe) achieve ~90% bony union.
• Corticocancellous grafts with plate stabilization yield the highest union rate (~99%).
• Prosthetic replacement shows satisfactory early results but poor late outcomes; proximal carpectomy is effective for severe osteoarthrosis; radiocarpal arthrodesis provides stability but sacrifices motion.

Conclusions:

• Surgical cure for scaphoid non-union should be attempted in most cases, excluding those with severe osteoarthritis or necrosis.
• Corticocancellous grafting with plate stabilization is the most effective curative treatment.
• Palliative options like prosthetic replacement and carpectomy have specific indications and limitations.