[Long-term outcome of reconstruction of proximal scaphoid pseudarthroses with Matti-Russe-plasty].

Thirty-two patients who were treated with Matti-Russe grafts between 1985 and 1995 after a fracture of the proximal scaphoid pole were examined in a retrospective study. The purpose of the study was the evaluation of the long-term results of functional outcome, radiological results, and postoperative quality of life. Main object of the study was to clarify whether the development of carpal collapse is inevitable or if it is correlated to the persistence of bony nonunion. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale from 0 to 100 (VAS). The analysis of the X-rays was carried out with a special wrist-score that was developed for the 1997 meeting of the German Speaking Society for Surgery of the Hand (DAH). The functional outcome was evaluated with the DASH-questionnaire. Twenty-nine patients were male, three were female. In 22 patients the right hand was involved, in ten patients the operation was performed on the left hand. The average follow-up period was 66 months. Bony union was achieved in 26 cases, six patients still demonstrated a persistent nonunion. The mean postoperative pain score was 1.8 (non-stress) and 42.5 (stress) in patients with scaphoid union. Active range of motion and grip strength were 90% compared to the contralateral side, the DASH-score reached 12.73. Only in persistent nonunion an advanced carpal collapse could be detected. The results show the reliability of the Matti-Russe graft in nonunion of fractures of the proximal pole of the scaphoid. Alternative treatment options have no advantages in bony union. The disadvantage of the Matti-Russe graft is the long period of immobilisation.