Outcomes after arthroscopic treatment for scaphoid nonunion using ipsilateral radius bone graft and a headless compression screw: a comparison between the patients with and without avascular necrosis

Lin, Ting-Yi; Fu, Chun-Wei; Tsai, Pei‐Shan; Huang, Chang‐Hung; Wei, Shun-Hua; Chuang, Min-Yao

doi:10.1007/s00264-023-05700-5

Cited by 5 publications

(2 citation statements)

References 34 publications

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“…Wong and Ho 18 defined the lack of punctate bleeding of the proximal scaphoid fragment as avascular necrosis but they were still able to achieve 81.8% union rate in such patients. Similarly, this finding was also supported by other reports in the literature, 19 , 35 , 36 , 37 and presence of scaphoid proximal pole avascularity did not appear to correlate with fracture healing potential. 35 , 38 …”

Section: Discussionsupporting

confidence: 89%

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Arthroscopic Bone Grafting and Robot‐assisted Fixation for Scaphoid Nonunion

Yi,

Lim,

Chen

et al. 2023

Orthopaedic Surgery

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ObjectivesScaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot‐assisted fixation for the treatment of scaphoid nonunions.MethodsPatients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)‐wires or a headless compression screw using a robotic navigation system.ResultsSix male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K‐wires. All the guidewires were placed with a single‐attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow‐up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient‐rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients.ConclusionArthroscopic bone grafting with robot‐assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single‐attempt using a robotic navigation system.

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Section: Discussionsupporting

confidence: 89%

“…Similarly, this finding was also supported by other reports in the literature, 19 , 35 , 36 , 37 and presence of scaphoid proximal pole avascularity did not appear to correlate with fracture healing potential. 35 , 38 …”

Section: Discussionsupporting

confidence: 89%