We reviewed the clinical and roentgenographic findings of 47 non-unions of a fracture of the scaphoid in 46 symptomatic patients in order to assess the incidence and severity of degenerative changes of the wrist. The duration of non-union ranged from 5 to 53 years. 3 roentgenographic patterns were seen: 23 lesions had sclerosis, cyst formation, or resorptive changes confined to the scaphoid bone (Group I); 14 had radioscaphoid arthritis (Group II); and 10 had generalized arthritis of the wrist (Group III). The duration of Group-I non-unions averaged 8.2 years; Group-II, 17.0 years; and Group-III non-unions, 31.6 years. Fracture displacement and carpal instability correlated with the severity of degenerative changes. Lunate dorsiflexion of 10 degrees or more was a useful guide to carpal instability. Few of the 47 non-unions were undisplaced, stable, or free of arthritis after 10 years. Based on the high probability of arthritis, we recommend that all displaced ununited scaphoid fractures be reduced and grafted, regardless of symptoms, before degenerative changes occur. Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.
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We reviewed the clinical and roentgenographic findings of 47 non-unions of a fracture of the scaphoid in 46 symptomatic patients in order to assess the incidence and severity of degenerative changes of the wrist. The duration of non-union ranged from 5 to 53 years. 3 roentgenographic patterns were seen: 23 lesions had sclerosis, cyst formation, or resorptive changes confined to the scaphoid bone (Group I); 14 had radioscaphoid arthritis (Group II); and 10 had generalized arthritis of the wrist (Group III). The duration of Group-I non-unions averaged 8.2 years; Group-II, 17.0 years; and Group-III non-unions, 31.6 years. Fracture displacement and carpal instability correlated with the severity of degenerative changes. Lunate dorsiflexion of 10 degrees or more was a useful guide to carpal instability. Few of the 47 non-unions were undisplaced, stable, or free of arthritis after 10 years. Based on the high probability of arthritis, we recommend that all displaced ununited scaphoid fractures be reduced and grafted, regardless of symptoms, before degenerative changes occur. Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.
Copyright remains with the authors and publisher.