Skaphoidpseudarthrose ohne Durchblutungsstörung: Management und Standardverfahren der primären Behandlung

TY - JOUR

T1 - Skaphoidpseudarthrose ohne Durchblutungsstörung: Management und Standardverfahren der primären Behandlung

AU - Yarar-Schlickewei, S

AU - Frosch, K H

AU - Schlickewei, C

PY - 2019/3

Y1 - 2019/3

N2 - Nonunion of the scaphoid is a severe complication of often insufficiently treated scaphoid fractures or those which have been diagnosed too late. The treatment of scaphoid nonunion is challenging und should be performed by experienced hand surgeons. The anatomical shape, the retrograde blood supply and the biomechanics of the scaphoid complicate the healing process. A delayed union or nonunion of the fractured scaphoid leads to persistent pain, restricted mobility and degenerative changes of carpal bones and wrist. The goal of treatment is bony healing of the pseudarthrosis with reconstruction of the anatomical shape and restoration of the axial alignment of the scaphoid. A prerequisite is the right choice of the different treatment options available. Fundamental to this is a careful pretherapeutic assessment as well as an individual classification of the pathological alterations and the morphological features of the nonunion. For this purpose, radiological cross-sectional imaging by means of computed tomography is essential. There is no consensus in the literature about the treatment of scaphoid nonunion. The available data do not enable the establishment of a superior treatment procedure. The most common surgical procedure used to treat scaphoid nonunion is autologous bone grafting combined with screw fixation. This article provides an up to date overview of the management and standard procedures for the primary treatment of scaphoid nonunion without a circulatory disorder.

AB - Nonunion of the scaphoid is a severe complication of often insufficiently treated scaphoid fractures or those which have been diagnosed too late. The treatment of scaphoid nonunion is challenging und should be performed by experienced hand surgeons. The anatomical shape, the retrograde blood supply and the biomechanics of the scaphoid complicate the healing process. A delayed union or nonunion of the fractured scaphoid leads to persistent pain, restricted mobility and degenerative changes of carpal bones and wrist. The goal of treatment is bony healing of the pseudarthrosis with reconstruction of the anatomical shape and restoration of the axial alignment of the scaphoid. A prerequisite is the right choice of the different treatment options available. Fundamental to this is a careful pretherapeutic assessment as well as an individual classification of the pathological alterations and the morphological features of the nonunion. For this purpose, radiological cross-sectional imaging by means of computed tomography is essential. There is no consensus in the literature about the treatment of scaphoid nonunion. The available data do not enable the establishment of a superior treatment procedure. The most common surgical procedure used to treat scaphoid nonunion is autologous bone grafting combined with screw fixation. This article provides an up to date overview of the management and standard procedures for the primary treatment of scaphoid nonunion without a circulatory disorder.

KW - English Abstract

KW - Journal Article

KW - Review

U2 - 10.1007/s00113-018-0596-2

DO - 10.1007/s00113-018-0596-2

M3 - SCORING: Review

C2 - 30617540

VL - 122

SP - 191

EP - 199

JO - UNFALLCHIRURGIE

JF - UNFALLCHIRURGIE

SN - 0177-5537

IS - 3

ER -