FRACTURE OF THE CARPAL NAVICULAR (SCAPHOID) BONE

An End-Result Study in Military Personnel

¹ Boston, Massachusetts

As the result of an end-result study of forty-four veterans who had fractures of the carpal navicular, recognized while in Military Service during World War II, the following conclusions seemed warranted:

1. If healing by primary union occurs, there is minimal residual disability which does not interfere with the performance of duty.

2. About 50 per cent. of the ununited fractures were surveyed from the Service for wrist symptoms. If non-union is established before induction, this injury should be disqualifying for full-duty status.

3. The incidence of non-union in Military Service was 22 per cent. The factors tending to produce non-union appeared to be insufficiently prolonged immobilization and delay in instituting treatment. Immobilization must be maintained until there is union as shown by x-ray. This may require more than eight weeks, even in acute fractures promptly diagnosed and treated.

4. The treatment of non-union in this series was unsatisfactory. Of the fourteen men with non-union, nine were treated conservatively without improvement; five were operated upon, union and a satisfactory result being obtained in two.

5. Persistent non-union results in partial absorption, displacement and fragmentation of the fragments, cyst formation in the navicular, and degenerative arthritic changes. Functional impairment was present in every case, but earning power was impaired in only 42 per cent. of the cases.

6. A psychiatric study of these patients revealed the personalities to be heterogeneous with no particular trait outstanding. In only six instances were there clearly discernible psychological factors related to the fracture or the veteran's adjustment following the fracture.

7. The work capacity of these injured wrists, as determined by a specially designed recording ergograph, in cases with primary union showed little or no impairment. Only one of the fourteen wrists with non-union showed a normal work capacity. The ergographic tracing in the uncooperative patient was characteristic and proved to be an aid in detecting lack of cooperation.

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