Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

Abstract

Background Arthroscopic management of scaphoid nonunions has been advanced as a less invasive technique that allows evaluation of associated intrinsic and extrinsic ligamentous injuries; however, few studies have documented the effectiveness of arthroscopic treatment of scaphoid nonunions and which intraarticular pathologies coexist with scaphoid nonunions. Questions/purposes (1) What are the outcomes of arthroscopic management of scaphoid nonunions as assessed by the proportion of patients achieving osseous union, visual analog scale (VAS) pain score, grip strength, range of motion, Mayo Wrist Score (MWS), and Disabilities of the Arm, Shoulder and Hand (DASH) score? (2) What complications are associated with arthroscopic scaphoid nonunion management? (3) What forms of intraarticular pathology are associated with scaphoid nonunions? Methods Between 2008 and 2012, we treated 80 patients surgically for scaphoid nonunions. Of those, 45 (56%) had arthroscopic management. During that time, our general indications for using an arthroscopic approach over an open approach were symptomatic scaphoid nonunions without necrosis of the proximal fragment, severe deformities, or arthritis. Of the patients treated arthroscopically, 33 (73%) were available for followup at least 2 years later. There were five distal third, 19 middle third, and nine proximal third fractures. The mean followup was 33 months (range, 24-60 months). Union was determined by CT taken at 8 to 10 weeks after operation with bridging trabecula at nonunion site. VAS pain scores, grip strength, active flexion-extension angle, MWS, and DASH scores were obtained preoperatively and at each followup visit. The coexisting intraarticular pathologies and complications were also recorded. Results Thirty-two (97%) scaphoid nonunions healed successfully. At the last followup, the mean VAS pain score decreased (preoperative: mean 4.

Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion

“…However, there are very few studies that have assessed scaphoid nonunions and associated intra-articular pathologies using wrist arthroscopy. 7,8,13,14 All these studies had strict inclusion and exclusion criteria and concentrated more on the arthroscopic technique of scaphoid ORIF and outcome than assessing associated intra-articular pathology. Ours is the first study to provide detailed intra-articular assessment of entire spectrum of concomitant pathology in established scaphoid nonunion.…”

“…[3][4][5] Around 50% of the patients with scaphoid nonunion have concomitant injuries to the wrist joint that could affect the long-term functional and radiologic outcome. [6][7][8] Neglected scaphoid nonunions can progress to arthritis. The prevalence increases from 22% in nonunions less than 5 years to 100% in 10 years.…”

“…Though some studies identified concomitant carpal pathologies in scaphoid nonunions, they were focused more on the management of the nonunion rather than detailed assessment of the whole radiocarpal and midcarpal joints. [6][7][8] Apart from considering concomitant injuries, when treating scaphoid nonunions, it is essential to know whether the bone is physically reconstructable but also whether there is excessive articular surface wear or other pathology that may exclude reconstruction. Though the state of the bone (e.g., fragmentation and bone loss) and blood supply is best assessed radiologically, arthroscopy remains the best method of assessing joint surface wear, dynamic ligament injuries, and other soft tissue injuries.…”

“…Though the state of the bone (e.g., fragmentation and bone loss) and blood supply is best assessed radiologically, arthroscopy remains the best method of assessing joint surface wear, dynamic ligament injuries, and other soft tissue injuries. [3][4][5][6][7][8][9][10] The aim of this study was to assess the usefulness of wrist arthroscopy in the management of scaphoid nonunions, assess associated intra-articular pathologies, and to evaluate its implications on the definitive treatment.…”

Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone

“…The union rate and healing potential with percutaneous [11][12][13][14][15] and arthroscopically assisted [16][17][18][19][20] techniques for the treatment of scaphoid nonunion have not been discussed at length. Indeed, comparative studies of different treatment options are rare in the literature.…”