Surgical treatment for nonunion of the carpal scaphoid.

Between 1978 and 1982, 23 male patients were operated on for delayed union or nonunion of scaphoid fractures. The average age of these patients at follow-up examination was 32.5 years. Twenty patients were treated by bone grafting using the Matti-Russe technique; in 2 patients the proximal fragment was excised for avascular necrosis, and in one patient a Swanson prosthesis was used. Bony union occurred in 18 patients treated with the Matti-Russe technique. The patients' subjective evaluations agreed with radiological results. Ten of the patients had no pain; 8 had pain only during strenuous activity, and 2 patients with subsequent nonunion had pains with moderate activity. Bony union with minor dislocation did not influence the results. Results according to radiological and clinical findings were judged to be excellent in 2 patients and good in 13 patients. According to the patients' own subjective evaluation, 7 assessed the results as excellent and 11 as good. At the follow-up examination 4 patients had normal gripping power, 9 had greater than 75% normal, 6 had greater than 50% and less than 75% normal, and 1 had less than 50% normal gripping power. In the 2 patients who underwent excision of the proximal pole of the scaphoid the result was good in one and poor in the other. For the patient whose scaphoid was replaced with an implant the result was good. Nineteen of the 23 patients returned to their previous work within 6 months of the operation.