[Personal experience with treatment of pseudoarthrosis of the navicular bone of the carpus].
OBJECTIVE
A displaced fracture of the scaphoid bone of the hand may result, according to some authors, in the development of pseudoarthrosis in 10 to 50% of the patients and aseptic necrosis of the proximal bone fragment may develop in 30 to 50% of them. Them surgical treatment of scaphoid bone pseudoarthrosis has recently made great progress and the results achieved by the authors in this field are reported in this paper. These results are discussed in light of the results and opinions presented at the 8th Congress of the World Federation for Hand Surgery held in Istambul in June 2001 and are compared with the achievements made by other authors and published in the most recent relevant literature.


METHODS
At our department, two standard surgical procedures are available to treat pseudoarthrosis of the scaphoid bone that is free from deforming changes due to arthritis. One approach involves resection of the pseudoarthrosis and subsequent cancellous bone grafting, using osseous tissue from the styloid process of the radius and osteosynthesis with a navicular screw. The other procedure is a modified arthroplasty according to Dwyer and is applied to cases which show aseptic necrosis of the proximal bone fragment. The follow-up study of the patients treated between 1997 and 2001 included patients in whom the follow-up period was at least six months. The results were evaluated according to Pechlaner's rating system.


RESULTS
A total of 26 patients were examined; the average time from the operation was 17 months. Of them, 24 underwent the primary treatment that involved resection of pseudoarthrosis followed by cancellous bone grafting and osteosynthesis with a screw. This primary operation healed the condition in 17 patients, but the rest of them had to undergo one or two more surgical procedures. Evaluation by Pechlaner's scoring system showed 14 excellent, five good, two sufficient and three poor outcomes of the treatment.


CONCLUSIONS
The pseudoarthrosis of the scaphoid bone, its diagnosis, surgical treatment and different operative techniques are discussed. Special attention is paid to the use of either vascularized rotatory grafts or pedicled vascularized grafts. The follow-up results are compared with those of other orthopedic clinics and hospitals. Various aspects of further improvement in the treatment of this disease under current conditions are considered.


CONCLUSIONS
The results achieved in the treatment of pseudoarthrosis of the scaphoid bone of the hand are comparable with those of other orthopedic hospitals. Adoption of more recent types of osteosyntheses in considered. For a potential introduction of the vascularized graft technique, the use of a vascularized graft collected from the dorsum of the distal radius is suggested. This method is also regarded as suitable for treatment of certain cases of aseptic necrosis of the lunate bone.
Lutonský
M
M
Ortopedická klinika FN, Hradec Králové.
Pellar
D
D
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000601:surgery*