Arthroscopic treatment of scaphoid nonunion, a new algorithm after six years practice

Introduction: Scaphoid nonunion is still a challenging problem in hand surgery. Till now most of the patients have been treated with open revision, bone grafting and internal stabilization. Arthroscopy plays an increasing role in hand surgery since the last decade. Three years after starting the use of arthroscopic treatment of scaphoid nonunion we analyzed our results and modified our therapy protocol. Material and Methods: In 2017, we started arthroscopic treatment of scaphoid nonunion at our department. Debridement is done arthroscopically as well as insertion of radius cancellous bone graft. Fixation has been accomplished with K-wires and/or head compression screws percutaneously, by help of x-ray. Till 2020, we treated 24 patients, observing three delayed unions, treated successfully by extra corporal shockwave therapy and modifying the fixation. Analyzing these results, we modified our fixation methods and all patients, got shockwave therapy additionally. Results: Comparing the success rate with the 28 operated after 2020, the adaption of our algorithm showed an improvement of our results concerning healing rate. There we found only one ongoing nonunion in the proximal 1/3. The median time to healing was comparable in the two groups, operation time showed no significant difference. After a median follow-up of 30 months, we found an excellent range of motion, a significant reduction in pain and grip strength matchable with the unaffected hand in all 52 patients. DASH and Mayo Wrist Score showed satisfactory results, and 45 patients came back to their earlier occupation and sports. Conclusion: Arthroscopy has a fix place in the algorithm for scaphoid nonunion in our institution. We think an adequate and stabile fixation adopted to the section of the nonunion is indispensable. The distal radius is a sufficient donor-site for cancellous bone grafting. Extra corporal shockwave therapy should be used routinely in scaphoid nonunion. Level of evidence: IV