Arthroscopic Management of Scaphoid Nonunions

Abstract

The difficulty in healing scaphoid nonunions is challenged further by the dynamic, unstable nature of the fracture-fragment interface. Recently, several investigators have introduced a minimally invasive technique for scaphoid nonunion repair, which has the advantages of minimal morbidity and accurate articular reduction, resulting in less postoperative stiffness and increased functional outcomes. However, failure to recognize the critical steps during minimally invasive surgery can result in incorrect treatment or limit any chances for successful bone repair. We reviewed the selected literature pertinent to arthroscopic techniques in the treatment of scaphoid nonunions. Furthermore, we presented a new arthroscopic approach that can be used in place of traditional formal open exposures in challenging cases of nonunion.

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

“…Arthroscopic surgery has the advantages of direct visualisation, facilitated debridement of the scaphoid nonunion site, and minimal violation of the scaphoid vascularity [17]. High union rates of approximately 84 to 100% are reported with this method [5,[21][22][23]. Though this minimally invasive technique has yielded good results with minimal morbidity, its use is still limited to scaphoid nonunion without a large bone defect [24].…”

“…Surgical procedures including bone graft and screw fixation are the gold standard treatments for scaphoid nonunion [3,4]. In comparison to percutaneous screw fixation and arthroscopic bone grafting, a combined volar and dorsal approach for bone grafting and screw fixation is thought to have inferior functional outcomes and prolonged recovery course because of the risks of a disrupted blood supply and scar formation [5]. However, the detailed recovery course and the functional and radiographic outcomes of this approach are rarely reported in the literature.…”

Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

“…6,14,15 To date, achievement of healing remains suboptimal possibly due to residual instability. 16 Ideally, treatment should restore anatomy while improving the mechanics of the wrist. Currently available techniques include internal fixation with bone grafting, vascularized bone grafting, bone stimulation, and recently plating.…”

Arthroscopic Bone Grafting for Scaphoid Nonunion: A Retrospective Study of 42 Cases

“…Les premières études rapportant les résultats cliniques et radiologiques de cette technique sont assez encourageantes. Outre le caractère moins enraidissant retrouvé par la majorité des auteurs, la préservation de la vascularisation du scaphoïde et le respect des structures capsulo-ligamentaires représentent deux éléments mis en avant (Jegal et al, 2015).…”