Arthroscopic-Assisted Scaphoid Nonunion Repair.

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Arthroscopy

Background:

• Scaphoid fractures are common carpal injuries with a high risk of nonunion, potentially leading to wrist arthritis.
• Traditional open repair can compromise vascularity and increase stiffness due to extensive dissection.
• Arthroscopic techniques offer an alternative to preserve soft tissues and visualize pathology.

Purpose of the Study:

• To describe a reproducible arthroscopic-assisted technique for scaphoid nonunion repair.
• To detail the use of percutaneous autologous distal radius bone grafting and headless compression screw fixation.
• To highlight the advantages of arthroscopic repair over traditional open methods.

Main Methods:

• Diagnostic wrist arthroscopy followed by debridement of the nonunion site via midcarpal portals.
• Percutaneous harvesting of autologous cancellous bone graft from the distal radius.
• Arthroscopic introduction of bone graft and fixation with headless compression screws, followed by graft augmentation and fibrin sealant.

Main Results:

• Arthroscopic repair allows for complete debridement, precise reduction, and biologically favorable bone grafting.
• Preservation of scaphoid vascularity and ligamentous structures.
• Reported union rates and clinical outcomes comparable to open surgery, with reduced donor site morbidity and maintained wrist motion.

Conclusions:

• Arthroscopic-assisted scaphoid nonunion repair is a reliable and biologically sound technique.
• It offers advantages in visualization, reduced morbidity, and preservation of wrist motion.
• This method provides an effective option for managing scaphoid nonunions.