Pseudarthrosis of the scaphoid: what place for conservative treatment using extracorporeal shock wave therapy?

Pseudarthrosis of the scaphoid is a relatively frequent complication (5-10%), the pathophysiology of which is linked in particular to poor vascularization, especially of the proximal pole. The optimal treatment for pseudarthrosis of the scaphoid has not yet been established and remains controversial. Among the non-surgical options, extracorporeal shock wave therapy (ESWT) has proved to be a reliable and effective non-invasive modality for patients with delayed or non-healing fractures. We report a retrospective study conducted in the Department of Physical and Rehabilitation Medicine at CHU Ibn Rochd, including 8 patients with scaphoid pseudarthrosis. Conservative radial shock wave therapy (ESWT) was performed over 4 sessions at 1-week intervals (3000 pulses per session, mean energy flux density 0.6 mJ/mm2). Clinical and radiological assessment was performed before treatment and two months after its completion. A significant improvement in algo-functional scores and complete consolidation of the pseudarthrosis site was achieved in 87.5% of patients. Extracorporeal shockwave therapy appears to be a reliable and effective non-invasive modality for the treatment of scaphoid pseudarthrosis.