Proximal pole reconstruction [ dorsal middle bone pain ]

Arthroscopic Bone Grafting for Scaphoid Nonunion

Introduction: Scaphoid fractures are often initially missed and then diagnosed only once nonunion manifests. Because the natural history of these fractures results in radiocarpal arthritis and ultimately midcarpal arthritis, they must be surgically treated. However, choice of treatment strategy is still controversial.

The techniques range from less invasive, such as percutaneous fi xation, to more invasive, such as autologous bone grafting from the iliac crest or vascularized bone grafts. Surgical treatment of nonunions can be minimally invasive with arthroscopy. This simplifi es postoperative recovery, reduces complications, and preserves the wrist’s capsule–ligament complex, and thus the scaphoid’s precarious vascularization.

Conclusion: Scaphoid nonunion is a common problem because the initial fracture can go undetected, and the bone is poorly vascularized. It can eventually progress to scaphoid nonunion advanced collapse (SNAC) and must be treated surgically before osteoarthritis set s in. Arthroscopic bone grafting is a simple, reliable technique that preserves vascularization, especially in patients with proximal pole nonunion.