Traitement des pseudarthroses du scaphoïde carpien par greffe corticospongieuse non vascularisée : étude rétrospective de 47 cas

Abstract

The authors report their results on the treatment of scaphoid non-unions without osteoarthritis or necrosis, by anterior nonvascularized bone graft.Forty-seven patients treated between 1988 and 2003 were analysed with a mean follow-up of 74 months. There were 19 non-unions without carpal instability (IIA) and 28 with carpal instability (IIB). All patients were treated by an anterior approach with corticocancellous bone graft and osteosynthesis using two pins. Clinical results were analysed on pain, strength and mobility. Radiographic analysis was of union, correction of instability and occurrence of osteoarthritis.These were divided into stages IIA and IIB: 1) stage IIA: all cases proceeded to bony union; ten results were excellent and nine good and no instability; there was one case of osteoarthritis; 2) stage IIB: 78% of patients proceeded to bony union; one result was excellent, 17 good, four moderate and six cases remained un-united. There were 12 cases of osteoarthritis. Most of them occurred in patients with residual instability after the initial surgical procedure.Corticocancellous nonvascularized bone graft by a palmar approach is an excellent technique for treatment of scaphoid non-unions without osteoarthritis and necrosis. The presence of instability is a poor prognostic factor; its correction during the operation allows the surgeon to decrease the risk of osteoarthritis.