Fractures and pseudarthrosis of the carpal scaphoid

The ultimate outcome of fractures of the scaphoid bone is determined by the choice of initial treatment. The special characteristics of the blood supply to the bone, which often increase the risk of non-union, have prompted us to propose the indications for primary surgical treatment based on the radiographic appearances. The authors propose a classification of the radiographic characteristics of fractures of the scaphoid for determining at the outset the treatment most likely to achieve consolidation and hence a more rapid resumption of occupational and sports activities. They present the results obtained in the treatment of 101 recent fractures of the scaphoid, eighty-one of which they were able to follow up after at least one year. In cases of established pseudarthrosis of the scaphoid they propose a pedicled transplant technique as conforming better to the anatomical, morphological and functional pre-requisites of the operation. The results obtained in the treatment of twenty-nine cases of pseudarthrosis are presented. The case material relates to patients treated at the G. Pini Orthopaedic Institute of Milan and, in the case of sportsmen, at the Centre for sports injuries of the same institute.