Prognostic factors in the treatment of carpal scaphoid non-unions.

In this literature review, the authors analyse the prognostic factors in the curative treatment of scaphoid non-unions. The main negative prognostic factors are smoking, the time elapsed since the fracture, and avascular necrosis of the proximal fragment. If the latter is present, the revascularization by a pedicle or microsurgical bone autograft is probably the treatment of choice. In non-unions without evidence of osteonecrosis, vascularized bone grafts are probably not superior to conventional bone grafts, which can presently be performed under arthroscopic control, with minimal morbidity.