LOCAL EXPERIENCE IN TREATMENT OF SCAPHOID NONUNION WITH AND WITHOUT AVASCULAR NECROSIS

Abstract

Early _
 detection and_ proper adequate treatment of scaphoid fractures are essential to avoid complications of ma lunion1 delayed union, nonunion and the avascular necrosis, with their disabling 
 sequelae The aim of this study is to assess prospectively the clinical and radiological results using 
 the modified Matt1:Russe technique , for the treatment of scaphoid nonunion with and without 
 questionable viability of the proximal fragment. With our experience of the numerous procedures 
 and techniques proposed for the treatment of this complex problem, we are reporting our results in 
 23 cases, 8 of which were associated with avascular necrosis of their proximal fragments. Although 
 the data were hm11ed for cases of nonunion scaphoid fracture, with proximal pole avascular necrosis, we noticed that mcreased bone density is a reliable sign of a vascularity. Our success rate in 
 cases without avascular necrosis was (93%) , while it was (75%) in the presence of avascular necrosis. Hence the conclusion was: The modified free bone grafting technique of Matti-Russe, which was 
 normally recommended for the treatment of scaphoid nonunion, is yet effective even in presence 
 of avascular necrosis; and with this technique fixation seems unnecessary.