Skip to main content
SpringerLink
Log in

Surgical treatment of scaphoid nonunion

Review of the literature and recommendations for treatment

  • Original Articles
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Summary

The management of scaphoid pseudarthrosis is still controversial. The numerous methods that have been proposed can be roughly classified according to their aim — relief of pain or healing of bone. Following a review of the literature, and guided by personal experience with the Matti-Russe technique and McLaughlin internal fixation, the authors present recommendations for treatment according to clinical presentation of the condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams JD, Leonard RD (1928) Fracture of the carpal scaphoid. N Engl J Med 198:401–404

    Google Scholar 

  2. Agner O (1963) Treatment of ununited fractures of the carpal scaphoid by Bentzon's operation Acta Orthop Scand 33:56–65

    PubMed  Google Scholar 

  3. Agner O (1963) Treatment of non-untid navicular fractures by total excision of the bone and insertion of acrylic prosthesis. Acta Orthop Scand 33:235–245

    PubMed  Google Scholar 

  4. Aleman O (1937/1938) Ein Beitrag zur Behandlung der Fractura Ossis navicularis carpi. Acta Chir Scand 80:217–237

    Google Scholar 

  5. Barnard L, Stubbins SG (1948) Styloidectomy of the radius in the surgical treatment of non-union of the carpal navicular. A preliminary report. J Bone Joint Surg [Am] 30:98–102

    Google Scholar 

  6. Bauer M (1985) Thirty-year follow-up of ankle fractures. Acta Orthop Scand 56:103–106

    PubMed  Google Scholar 

  7. Beck A (1929) Zur Behandlung der verzögerten Konsolidation bei Unterschenkelbrüchen. Zentralbl Chir 56: 2690–2692

    Google Scholar 

  8. Bentzon PGK, Randlöv-Madsen A (1945) On fracture of the carpal scaphoid. Acta Orthop Scand 16:30–39

    Google Scholar 

  9. Boeckstyns MEH, Busch P (1984) Surgical treatment of scaphoid pseudarthrosis: evaluation of the result after soft tissue arthroplasty and inlay bone grafting. J Surg 9:378–382

    Google Scholar 

  10. Böhler L, Trojan E, Jahna H (1954) Behandlungsergebnisse von 734 frischen einfachen Brüchen des Kahnbeinkörpers der Hand. Wiederherstellungschir u Traum 2:86–111

    Google Scholar 

  11. Bora FW, Osterman AL, Brighton CT (1981) The electrical treatment of scaphoid non-union. Clin Orthop 161:33–38

    PubMed  Google Scholar 

  12. Bora FW, Osterman AL, Woodbury DF, Brighton CT (1984) Treatment of non-union of the scaphoid by direct current. Orthop Clin North Am 15:107–112

    PubMed  Google Scholar 

  13. Broström LA, Stark A, Svartengren G (1986) Non-union of the scaphoid treated with compression screw fixation and styloidectomy. Scand J Plast Reconstr Surg 20:289–291

    PubMed  Google Scholar 

  14. Bunell S (1944) Surgery of the hand. Lippincott, Philadelphia, pp 203–208

    Google Scholar 

  15. Butler AA (1949) Arthrodesis of the wirst, joint. Am J Surg 78:625–630

    PubMed  Google Scholar 

  16. Cobey MC, White RK (1946) An operation for non-union of fractures of the carpal navicular. J Bone Joint Surg 28: 757–765

    Google Scholar 

  17. Cooney WP, Dobyns, JH, Linscheid RL (1980) Nonunion of the scaphoid. Analysis of the results from bone grafting. J Hand Surg 5:343–354

    Google Scholar 

  18. Crabbe WA (1964) Excision of the proximal row of the carpus. J Bone Joint Surg [Br] 46:708–711

    Google Scholar 

  19. Davidson AJ, Horwitz MT (1938) An evaluation of excision in the treatment of ununited fracture of the carpal scaphoid (navicular) bone. Ann Surg 108:291–295

    Google Scholar 

  20. Dickison JC, Shannon JG (1944) Fractures of the carpal scaphoid in the canadian army. Surg Gynecol Obstet 79: 225–239

    Google Scholar 

  21. Dooley BJ (1968) Inlay bone grafting for non-union of the scaphoid bone by the anterior approach. J Bone Joint Surg [Br] 50:102–109

    Google Scholar 

  22. Dunn AW (1972) Fractures and dislocations of the carpus. Surg Clin North Am 52:1513–1538

    PubMed  Google Scholar 

  23. Dwyer FC (1949) Excision of the carpal scaphoid for ununited fracture. J Bone Joint Surg [Br] 31:572–577

    Google Scholar 

  24. Eddeland A, Eiken O, Hellgren E, Ohlsson NM (1975) Fractures of the scaphoid. Scand J Plast Reconstr Surg 9: 234–239

    PubMed  Google Scholar 

  25. Edelstein JM (1939) Treatment of ununited fractures of the carpal navicular. J Bone Joint Surg 21:902–908

    Google Scholar 

  26. Eiken O, Ekerot L, Lindström C, Jonsson K (1985) Silicone carpal implants: risk or benefit? Scand J Plast Reconstr Surg 19:295–304

    PubMed  Google Scholar 

  27. Ekerot L, Holmberg J, Eiken O (1983) Denervation of the wrist. Scand J Plast Reconstr Surg 17:155–157

    PubMed  Google Scholar 

  28. Fisk GR (1970) Carpal instability and the fractured scaphoid. Ann R Coll Surg Engl 46:63–76

    PubMed  Google Scholar 

  29. Fish GR (1984) The wrist. J Bone Joint Surg [Br] 66:396–407

    Google Scholar 

  30. Gasser H (1965) Delayed union and pseudarthrosis of the carpal navicular: treatment by compression screw osteosynthesis. J Bone Joint Surg [Am] 47:249–266

    Google Scholar 

  31. Geissendörfer H (1941) Erfolgreiche Behandlung veralteter Kahnbeinbrüche der Hand durch Nagelung. Zentralbl Chir 8:343–346

    Google Scholar 

  32. Geissendörfer H (1950) Erfahrungen und Ergebnisse mit der Nagelung bei 21 veralteten Kahnbeinbrüchen. Zentralbl Chir 13:906–912

    Google Scholar 

  33. Gieseking H (1951) Die Nagelung als Behandlungsmaßnahme beim frischen und alten Kahnbeinbruch. Z Orthop 80:597–605

    PubMed  Google Scholar 

  34. Glass KS, Hochberg F (1978) Nonunion of the carpal navicular bone: comparison of two methods of treatment. Bull NY Acad Med 54:865–868

    Google Scholar 

  35. Goeringer CF (1949) Follow-up results of surgical treatment for non-union of the carpal scaphoid bone. Arch Surg 58:291–307

    Google Scholar 

  36. Graner O, Lopes EJ, Carvalho BC, Atlas C (1966) Arthrodesis of the carpal bones in the treatment of Kienböcks disease. J Bone Joint Surg [Am] 46:767–774

    Google Scholar 

  37. Herbert TJ, Fischer WE (1984) Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg [Br] 66:114–123

    Google Scholar 

  38. Herness D, Posner MA (1977) Some aspects of bone grafting for non-union of the carpal navicular. Acta Orthop Scand 48:373–378

    PubMed  Google Scholar 

  39. Hirsch M (1935) Konservative oder operative Therapie der Fraktur des Os naviculare carpi. Wien Med Wochenschr 85:803–804

    Google Scholar 

  40. Kaufman/Hirsch M (1914) Die Verletzungen der Handwurzel. Ergebn Chir Orthop 8:718–782

    Google Scholar 

  41. Kristensen KD, Andersen HJ, Sörensen JG, Rasmussen J, Nielsen S (1983) Non-union i os scaphoideum behandled a.m. Matti-Russe. Ugeskr Laeger 145:3016–3017

    PubMed  Google Scholar 

  42. Leyshon A, Ireland J, Trickey EL (1984) The treatment of delayed union and non-union of the carpal scaphoid by screw fixation. J Bone Joint Surg [Br] 66:124–127

    Google Scholar 

  43. Lindström G (1975) Scaphoideumfrakturer. Thesis, Gothenburg

  44. Maatz R (1943) Schraubung der Kahnbeinpseudarthrose. Zentralbl Chir 70:1720–1721

    Google Scholar 

  45. Mack GR, Bosse MJ, Gelberman RH, Yu E (1984) The natural history of scaphoid non-union. J Bone Joint Surg [Am] 66:504–509

    Google Scholar 

  46. Matti H (1937) Über die Behandlung der Navicularfraktur und der Refractura patellae durch Plombierung mit Spongiosa. Zentralbl Chir 64:2353–2359

    Google Scholar 

  47. Maudsley RH, Chen SC (1972) Screw fixation in the management of the fractured carpal scaphoid. J Bone Joint Surg [Br] 54:432–441

    Google Scholar 

  48. Mazet R, Hohl M (1960) Radial styloidectomy and styloidectomy plus bone graft in the treatment of old ununited carpal scaphoid fractures. Ann Surg 152:296–302

    Google Scholar 

  49. Mazet R, Hohl M (1963) Fractures of the carpal navicular. J Bone Joint Surg [Am] 45:82–112

    Google Scholar 

  50. McLaughlin HL (1954) Fracture of the carpal navicular (scaphoid) bone. J Bone Joint Surg [Am] 36:765–819

    Google Scholar 

  51. McLaughlin HL (1969) Fracture of the carpal navicular (scaphoid) bone: gradiations in therapy based upon pathology. J Trauma 9:311–319

    PubMed  Google Scholar 

  52. Merle D'Aubigné R, Lataste J (1956) Les arthrodeses du poignet. Rev Chir Orthop 42:185–206

    PubMed  Google Scholar 

  53. Mulder JD (1968) The results of 100 cases of pseudarthrosis in the scaphoid bone treated by the Matti-Russe operation. J Bone Joint Surg [Br] 50:110–115

    Google Scholar 

  54. Murray G (1946) End results of bone-grafting for non-union of the carpal navicular. J Bone Joint Surg 28:749–756

    Google Scholar 

  55. Narr H (1982) Indikationsbereiche, Technik und Ergebnisse der Handgelenksarthrodese. Unfallheilkunde 85:171–177

    PubMed  Google Scholar 

  56. Neviaser RJ (1983) Proximal row carpectomy for posttraumatic disorders of the carpus. J Hand Surg 8:301–305

    Google Scholar 

  57. Obletz BE, Halbstein BM (1938) Non-union of fractures of the carpal navicular. J Bone Joint Surg 20:425–428

    Google Scholar 

  58. Pagenstecher H, Hirsch M (1914) Die Verletzungen der Handwurzel. Ergebn Chir Orthop 8:718–742

    Google Scholar 

  59. Palmer J, Widen A (1955) Treatment of fractures and pseudarthrosis of the scaphoid with central grafting Acta Chir Scand 110:206–212

    PubMed  Google Scholar 

  60. Perey O (1954) A re-examination of cases of pseudarthrosis of the navicular bone operated on according to Bentzons' technique. Acta Orthop Scand 23:26–33

    Google Scholar 

  61. Randlöv A (1955) Treatment of pseudarthroses of the os naviculare carpi. Acta Orthop Scand 24:341–343

    Google Scholar 

  62. Rayan GM, Clark GL (1982) Combined radiocarpal intercarpal arthrodesis. Orthopäde 5:541–550

    Google Scholar 

  63. Razemon JP, Philippe E (1972) L'Arthrodese du poignet dans les pseudarthroses du scaphoide carpien. Rev Chir Orthop 58:712–714

    PubMed  Google Scholar 

  64. Russe O (1960) Fracture of the carpal navicular. J Bone Joint Surg [Am] 42:759–768

    Google Scholar 

  65. Schmitt E, Hassinger M, Schmitt O, Mittelmeier H (1983) Behandlung der irreparablen Kahnbeinpseudarthrosen und Nekrosen mit Teilresektion des Os scaphoideum. Handchirurgie 15:185–190

    Google Scholar 

  66. Schneck F (1930) Die Behandlung der verzögerten Callusbildung des Os naviculare manus mit der Beck'schen Bohrung. Zentralbl Chir 42:2600–2603

    Google Scholar 

  67. Schneider LH, Aulicino P (1982) Nonunion of the carpal scaphoid: the Russe procedure. J Trauma 22:315–319

    PubMed  Google Scholar 

  68. Smith L, Friedman B (1956) Treatment of ununited fractures of the carpal navicular by styloidectomy of the radius. J Bone Joint Surg [Am] 38:368–376

    Google Scholar 

  69. Soto-Hall R, Haldeman KO (1934) Treatment of fractures of the carpal scaphoid. J Bone Joint Surg 16:822–828

    Google Scholar 

  70. Soto-Hall R, Haldeman KO (1941) The conservative and operative treatment of fractures of the carpal scaphoid (navicular). J Bone Joint Surg 23:841–850

    Google Scholar 

  71. Speed K (1935) Fractures of the carpus. J Bone Joint Surg 17:965–968

    Google Scholar 

  72. Speed K (1937) Small bone repair. Surg Gynecol Obstet 64:9–15

    Google Scholar 

  73. Speed K, Knight RA (1956) Campbell's operative orthopaedics, 3rd edn. Mosby, St. Louis

    Google Scholar 

  74. Stark A, Broström LÅ, Svartengren G (1987) Scaphoid non-union treated with the Matti Russe technique. Clin Orthop 214:175–180

    PubMed  Google Scholar 

  75. Stewart MJ (1954) Fractures of the carpal navicular (scaphoid). J Bone Joint Surg [Am] 36:998–1006

    Google Scholar 

  76. Sutro CJ (1946) Treatment of nonunion of the carpal navicular bone. Surgery 20:536–540

    Google Scholar 

  77. Swanson AB (1970) Silicone rubber implants for the replacement of the carpal scaphoid and lunate bones. Orthop Clin North Am 1:299–309

    PubMed  Google Scholar 

  78. Törngren S, Sandqvist S (1974) Pseudarthrosis in the scaphoid bone treated by grafting with autogenous bone peg. Acta Orthop Scand 45:82–88

    PubMed  Google Scholar 

  79. Unger HS, Stryker WC (1969) Nonunion of the carpal navicular. South Med J 62:620–622

    PubMed  Google Scholar 

  80. Verdan C, Narakas A (1968) Fractures and pseudarthrosis of the scaphoid. Surg Clin North Am 48:1083–1095

    PubMed  Google Scholar 

  81. Wagner CJ (1952) Fractures of the carpal navicular. J Bone Joint Surg [Am] 34:774–787

    Google Scholar 

  82. Waugh RL, Reuling L (1945) Ununited fractures of the carpal scaphoid. Am J Surg 67:184–200

    Google Scholar 

  83. Wilhelm A (1965) Die Denervation der Handwurzel. Hefte Unfallheilkd 81:109–114

    PubMed  Google Scholar 

  84. Zemel NP, Stark HH, Asworth CR, Rickard TA, Anderson DR (1984) Treatment of selected patients with an ununited fracture of the proximal part of the scaphoid by excision of the fragment and insertion of a carved silicone rubber spacer. J Bone Joint Surg [Am] 66:510–517

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Karolinska Hospital, P.O. Box 60500, S-10401, Stockholm, Sweden

    A. Stark & L. Å. Broström

  2. Department of Hand Surgery, Sabbatsberg Hospital, Stockholm, Sweden

    G. Svartengren

Authors
  1. A. Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Å. Broström
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Svartengren
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stark, A., Broström, L.Å. & Svartengren, G. Surgical treatment of scaphoid nonunion. Arch Orthop Trauma Surg 108, 203–209 (1989). https://doi.org/10.1007/BF00936202

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00936202

Keywords

Search

Navigation