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Arthroscopic Treatment of Scaphoid Nonunion With Cancellous Bone Graft and Percutaneous Fixation

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using cancellous bone graft and percutaneous internal fixation.

Between March 2019 and October 2023, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic debridement, cancellous bone graft (iliac crest or distal radius) and volar percutaneous fixation were included in this study. One senior surgeon alternatively performed arthroscopic osteosynthesis percutaneously either with a cannulated headless compression screw or/and Kirschner (K)-wires. The character of all the patient were record. Preoperative and postoperative measurements included the visual analog scale (VAS) score for pain; wrist range of motion (ROM); grip strength; the Modified Mayo Wrist Score; the Quick/Disabilities of the Arm, Shoulder and Hand (DASH) score. The bone union rate and time were also evaluated. The outcomes between groups of patients with different conditions were analyzed.

Twenty-three patients were included. All cases were delayed presentations (n = 16) or failed nonoperatively managed scaphoid fractures (n = 7). Surgery was performed at a mean duration of 27 (7 to 120) months following injury. arthroscopic-assisted iliac crest bone graft in 8 wrist, distal radius in 15. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 4 wrists, a headless screw in 17, and a combination of a headless screw and single K-wire in two. Intraoperatively, established avascular necrosis of the proximal fragment was identified in ten scaphoids. All fractures united within 16 weeks, confirmed by CT. The average time to union was 15.3 weeks. The average follow-up period was 32.5 (12 to 64) months. At final follow-up, no peri- or postoperative complications were encountered. There were significant improvements after surgery in the Modified Mayo Wrist Score, DASH score, wrist ROM, grip strength, and the VAS pain score (P < .001).

Our data indicate that arthroscopic pure cancellous bone auto-grafting and volar percutaneous internal fixation with a cannulated headless compression screw or/and K-wires is a viable method in treating scaphoid nonunions. It provided satisfactory outcomes regardless of the vascularity of the proximal fragment, chronicity, location, and severity of nonunion.

arthroscopic; scaphoid nonunion, cancellous bone graft