Evaluation of Treatment for Non-Union of the Carpal Navicular

¹ Pittsburgh
² Lancaster
³ Lewistowmi
⁴ Erie
⁵ Philadelphia

A total of seventy-three cases of treated non-union of fracture of the carpal navicular has been collected from orthopaedic surgeons in Pennsylvania.

Our statistics parallel all other published data as to sex, age distribution, and location of the fracture.

Despite increasing awareness of the subtle nature of this fracture, particularly after the experience gained in the Armed Services, it is quite obvious that the majority of these injuries remain undiagnosed and, if they are diagnosed, the majority are inadequately treated. In this series 85 per cent of the fractures occurred as an isolated injury, thus increasing the likelihood of this lesion being missed.

The presenting clinical complaint is pain in the wrist. Progressive loss of motion and function signal the presence of avascular necrosis or of local arthritic changes. On the average, patients in this series waited thirty-six months before seeking treatment.

In this series, non-union was already present in 76 per cent of the patients when they were first seen by an orthopaedic surgeon. Also, when first seen, 39 per cent had avascular necrosis of a fragment and 34 per cent showed local arthritic changes.

In twenty-five patients in this series bone-pegging, with or without styloidectomy, tended to be done early amid resulted in bone union in 76 per cent. The functional end result was rated excellent or good in 81 per cent.

Styloidectomy alone in this series was done late after the development of local arthritic changes. It resulted in healing of the non-union in only two of the eight patients, but the functional end result was rated excellent or good in five.

Excision of the proximal fragment in this series was done in ten patients with avascular necrosis preoperatively. The functional end result was rated excellent or good in all patients doing light work and fair or poor in those doing heavy work.

A Fett prosthesis was used in eight patients by two surgeons; all were rated moderately or severely disabled before operation. After treatment, the functional results were rated excellent in all eight patients.

The patients who waited the longest before seeking treatment tended to be severely disabled; in these fusion was done.

It would seem from this small series that no one method of treatment can be used for types of disability caused by an ununited fracture of the carpal navicular. All the methods studied seemed to give good results in some cases. In truth, it would appear that a well stocked surgical armamentarium ready for any contingency does exist.

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