The natural history of scaphoid non-union
A retrospective radiographic and clinical analysis of 102 symptomatic patients with 104 scaphoid non-unions of at least 1 year's duration was conducted. Osteoarthritis occurred in 22% of non-unions of less than 5 years' duration, 75% of those of 5 to 9 years' duration, and 100% of those of 10 years' duration or more. An all-over incidence of osteoarthritis in the wrist was 55%. Osteoarthritic changes occurred initially at the scaphoid-radial styloid joint which were manifested by radial styloid pointing and/or dorsal radioscaphoid osteophyte formation, later progressing to the midcarpal joint. Osteoarthritis at the scaphoid-radial styloid joint was significantly associated with dorsiflexed intercalated segment instability (DISI) deformity. An overall incidence of DISI deformity of the wrist was 56%, and the frequency of DISI pattern increased with longer duration of non-union. There was an increased incidence of avascular necrosis of the proximal fragment with time, especially after 20 years. There was no correlation between symptoms of pain and the severity of arthritis or the duration of non-union, but a good correlation between the duration of non-union and reduced grip strength or decreased wrist motion. A symptomatic non-union of the scaphoid is significantly likely to progress to osteoarthritis according to a predictable sequence, becoming worse both radiographically and clinically with time.
KeywordsPublic Health Arthritis Osteoarthritis Natural History Symptomatic Patient
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- 1.Cooney WA, Dobyns JH, Linscheid RL (1980) Fractures of the scaphoid. A rational approach to management. Clin Orthop 149:90–97Google Scholar
- 2.Dickson JC, Shannon JG (1944) Fractures of the carpal scaphoid in the Canadian Army. A review and commentary. Surg Gynec Obstet 79:225–239Google Scholar
- 3.Fisk GR (1970) Carpal instability and the fractured scaphoid. Ann R Coll Surg Engl 46:46–63Google Scholar
- 4.London PS (1961) The broken scaphoid bone. The case against pessimism. J Bone Joint Surg [Br] 43:237–244Google Scholar
- 5.Mack GR, Bosse MJ, Gelberman RH, Yu Eric (1984) The Natural History of Scaphoid Non-Union. J Bone Joint Surg 66-A:504–509Google Scholar
- 6.Mazet R Jr, Hohl M (1963) Fractures of the carpal navicular. Analysis of ninety-one cases and review of the literature. J Bone Joint Surg [Am] 45:82–112Google Scholar
- 7.Ruby LK, Stinson J, Belsky MR (1985) The natural history of scaphoid non-union. A review of fifty-five cases. J Bone Joint Surg [Am] 67:428–432Google Scholar
- 8.Vender MI, Watson HK, Wiener BD, Black DM (1987) Degenerative change in symptomatic scaphoid nonunion. J Hand Surg [Am] 12:514–519Google Scholar
- 9.Youm Y, McMurtry RY, Flatt AE, Gillespie TE (1978) Kinematics of the wrist. I. An experimental study of radio-ulnar deviation and flexion-extension. J Bone Joint Surg [Am] 60:423–431Google Scholar