SURGICAL AND CONSERVATIVE TREATMENT OF SC APHOID PSEUDOARTHROSIS

Should an asymptomatic scaphoid pseudarthrosis be eliminated by surger y? Two patient populations were followed up in order to be able to ans wer this central question. The first group comprised 49 unoperated pat ients and the second group 55 patients in whom Matti Russe reconstruct ive surgery had led to healing of the bone and in whom the operation h ad been carried out at least three years previously. The period of obs ervation was up to 25 years. The study yielded the following findings: 1. The spontaneous course automatically terminates in radiocarpal art hrosis. 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 fractur e, left-or righthandedness nor the patient's occupation affect the cou rse. Only necrosis of the proximal fragment favors the development of arthrosis. 3. The operated patients have much better results both clin ically and radiologically. The development of arthrosis is slowed down (but not stopped) by the operation. 4. A DISI deformity left behind a fter the operation does not affect the development of arthrosis. 5. Th e 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.