Is arthroscopic-assisted treatment applicable for the treatment of pediatric scaphoid nonunion?

Pediatric scaphoid nonunion is uncommon. Immobilization is initially attempted; however, it causes delays in both intervention and healing. Therefore, surgical intervention has gained broader acceptance and has been implemented in recent years. Among these, arthroscopic management has emerged as a contemporary technique. This study evaluated the clinical outcomes of pediatric scaphoid nonunion treated with arthroscopic-assisted bone grafting and Kirschner (K) wire fixation. Six pediatric patients with scaphoid nonunion treated with arthroscopic bone grafting and K-wire fixation between November 2009 and August 2021 were retrospectively reviewed. All included patients were male. Fracture locations included three distal thirds, two mid-thirds, and one proximal third. The mean time from injury to intervention was 7.83 months. Three patients underwent autogenous iliac bone grafting, and 3 received bone substitute grafts. The mean follow-up duration was 40.67 months. Bone union was evaluated using serial plain radiographs and computed tomography. Functional outcomes were assessed by comparing range of motion (ROM), grip strength, modified Mayo wrist score, quick disabilities of the arm, shoulder, and hand (DASH) score, and visual analog scale (VAS) before surgery and at the latest follow-up. Radiological assessment was performed by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. Complete union was achieved in all patients. The mean time to radiological union was 9.83 weeks. Functional measures, including grip strength (% of normal side, 67→92), ROM (% of normal side, 77→94), average VAS score (4.17→0.83), quick DASH score (40.15→7.58), and modified Mayo wrist score (53.33→80.00), demonstrated significant improvement. Radiological analysis also demonstrated a significant improvement in the SL angle (59.83→50.92). Arthroscopic-assisted bone grafting with percutaneous K-wire fixation is an effective treatment modality for pediatric scaphoid nonunions. In addition, bone substitute grafts may serve as viable alternatives to autogenous bone grafts in pediatrics.