Arthroscopic-Assisted Scaphoid Nonunion Repair

Scaphoid fractures represent the most common carpal fracture and carry a risk of nonunion, particularly when diagnosis is delayed, fixation is inadequate, or the proximal pole is involved because of limited vascularity. Nonunion can result in carpal collapse and degenerative wrist arthritis if untreated. Traditional open repair techniques provide access for debridement and bone grafting but often require capsular and ligamentous dissection that may compromise vascularity and increase postoperative stiffness. Arthroscopic-assisted scaphoid nonunion repair has emerged as an alternative that preserves soft tissue integrity while allowing direct visualization of the nonunion site and associated intra-articular pathology. This article describes a reproducible arthroscopic-assisted technique for scaphoid nonunion repair using percutaneous autologous distal radius bone grafting and headless compression screw fixation. Following diagnostic wrist arthroscopy, the nonunion interface is debrided under direct visualization from the midcarpal portals to healthy bleeding bone. Deformities can be corrected through percutaneous arthroscopic-assisted means. Autologous cancellous bone graft is harvested from the distal radius and introduced arthroscopically into the nonunion site. Fixation is achieved with one or two headless compression screws depending on bone quality and nonunion location, followed by graft augmentation and fibrin sealant application. Arthroscopic-assisted scaphoid nonunion repair facilitates complete debridement, precise reduction, and biologically favorable bone grafting while preserving the scaphoid's vascular and ligamentous structures. Reported union rates and clinical outcomes are comparable to open approaches, with advantages including improved visualization, reduced donor site morbidity, and maintenance of wrist motion. This technique provides a reliable and biologically sound option for managing scaphoid nonunions.