[Results of 193 conservatively treated acute fractures of the carpal navicular--indications for operative treatment (author's transl)].

The results of 193 conservatively treated acute fractures of the carpal navicular are presented. Ninety-eight (50.7%) had horizontal oblique fractures, 82 (42.5%) transverse, and 13 (6.8%) vertical oblique fractures. In 23 (11.9%) cases the fracture was located in the proximal third, in 125 (64.7%) in the middle third, and in 45 (23.4%) in the distal third. An unpadded cast extending from the elbow to the metacarpophalangeal joints including the thumb was used generally. On the following day the cast was always completed by addition of a volar plaster splint and a circular plaster bandage. Duration of immobilization lasted from 6 to 16 weeks (mean: 10 weeks). On average, 4.5 years after injury 190 (98.4%) fractures had healed by osseous union and 3 (1.6%) had a pseudarthrosis. The reasons for non-union were too short time of immobilization, and former diastasis between the fragments. The number of arthrosis in the radiocarpal joint in our patients amounted to less than 1%. Primary operative treatment (open reduction and screwing) is preferred for vertical oblique fractures and for fractures with a large diastasis between the fragments. Secondary operative treatment is performed if there are no signs of osseous consolidation.