[Surgical and conservative therapy of scaphoid pseudarthrosis]

Should an asymptomatic scaphoid pseudarthrosis be eliminated by surgery? Two patient populations were followed up in order to be able to answer this central question. The first group comprised 49 unoperated patients and the second group 55 patients in whom Matti Russe reconstructive surgery had led to healing of the bone and in whom the operation had been carried out at least three years previously. The period of observation was up to 25 years. The study yielded the following findings: 1. The spontaneous course automatically terminates in radiocarpal arthrosis. It begins after five to ten years in the radiocarpal joint and also affects the intracarpal joint after a further ten years. Besides an increasing shortening of the scaphoid bone, an exacerbating carpus collapse can also be observed. 2. Neither the position of the fracture, left- or righthandedness nor the patient's occupation affect the course. Only necrosis of the proximal fragment favors the development of arthrosis. 3. The operated patients have much better results both clinically and radiologically. The development of arthrosis is slowed down (but not stopped) by the operation. 4. A DISI deformity left behind after the operation does not affect the development of arthrosis. 5. The earlier the operation is carried out, the more favorable the course. 6. We attribute the relatively high rate of arthrosis in Matti-Russi reconstructive operation (69%) to an excessively long immobilization. For this reason, we prefer internal fixation with a Herbert screw.