Arthroscopic treatment for nonunion of the scaphoid

Abstract

Scaphoid nonunion has traditionally been treated by open surgery where the pseudarthrosis has been cleaned while either a structural wedged bone graft, or chips of cancellous bone has been used to fill the defect. K-wires or a screw has been used to stabilize the bone. Using the arthroscopic technique for treatment of nonunion of the scaphoid gives us small exposure to the joint, however with an excellent view of the bones, the articular surfaces and the intraarticular ligaments. The results from arthroscopic treatment for scaphoid nonunion with bone grafting using chips of cancellous bone are as good as from the open technique. The arthroscopic treatment, though, helps us to diagnose and treat concomitant lesions. There is less damage of blood supply, nerves and capsule, which might lead to a faster recovery and rehabilitation. The technique will be described and discussed.

Zusammenfassung

Herkömmlicherweise werden Kahnbeinpseudarthrosen offen operiert, dabei die Pseudarthrose ausgeräumt, der resultierende Defekt entweder mit einem Knochenblock oder mit Spongiosachips aufgefüllt und das Kahnbein mit Schrauben oder Kirschnerdrähten stabilisiert. Bei der arthroskopischen Behandlung von Kahnbeinpseudarthrosen sind die Zugänge sehr klein, bieten aber trotzdem eine ausgezeichnete Sicht auf Knochen, Gelenkflächen und Bänder der Handwurzel. Die Ergebnisse der arthroskopischen Behandlung von Kahnbeinpseudarthrosen entsprechen denen des offenen Vorgehens. Vorteil der arthroskopischen Behandlung ist, dass gleichzeitig bestehende Bandverletzungen diagnostiziert und behandelt werden können, die Blutversorgung weniger beeinträchtigt wird und das Risiko einer Nervenverletzung und von Narbenadhäsionen geringer ist, was Genesung und Rehabilitation erleichtern mag. In dieser Arbeit wird die Technik der arthroskopischen Behandlung von Kahnbeinpseudarthrosen dargestellt und diskutiert.

Key words

Scaphoid nonunion - arthroscopy - arthroscopic treatment

Schlüsselwörter

Kahnbeinpseudarthrose - Arthroskopie - arthroskopische Behandlung

Publication History

Received: 30 July 2020

Accepted: 17 August 2020

Article published online:
29 September 2020

• References

• 1 Linscheid RL, Dobyns JH, Beabout JW. et al. Traumatic instability of the wrist: diagnosis, classification and pathomechanics. J Bone Joint Surg Am 1972; 54: 1612-1632
• 2 Vender MI, Watson HK, Wiener BD. et al. Degenerative Change in Symptomatic Scaphoid Nonunion. J Hand Surg Am 1987; 12: 514-519
• 3 Mack GR, Bosse JM, Gelberman RH. et al. The natural history of scaphoid non-union. J Bone Joint Surg Am 1984; 66: 504-509
• 4 Ruby LK, Stinson J, Belsky MR. The Natural History of Scaphoid Non-Union. A Review of Fifty-Five cases. J Bone Joint Surg Am 1985; 67: 428-432
• 5 Gelberman RH, Wolock BS, Siegel DB. Current concepts review: fractures and nonunions of the carpal scaphoid. J Bone Joint Surg Am 1989; 71: 1560-1565
• 6 Slade III JF, Dodds SD. Minimally Invasive Management of Scaphoid Nonunions. Clin Orthop Relat Res 2006; 445: 108-119
• 7 Wong CWY, Ho PC. Minimal invasive management of scaphoid fractures-From fresh to nonunion: acute scaphoid fracture, scaphoid delayed union and nonunion. Hand Clinic 2011; 27: 291-307
• 8 Gupta V, Rijal L, Jawed A. Managing scaphoid fractures. How we do it?. J Clin Orthop Trauma 2013; 4: 3-10
• 9 Jørgsholm P, Thomsen NO, Björkman A. et al. The incidence of intrinsic and extrinsic ligament injuries in scaphoid waist fractures. J Hand Surg Am 2010; 35: 368-374
• 10 Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 2010; 23: 2-16
• 11 Leclercq C, Mathoulin C, Members of EWAS. Complications of Wrist Arthroscopy: A Multicenter Study Based on 10,107 Arthroscopies. J Wrist Surg 2016; 5: 320-326
• 12 del Piñal F, García-Bernal FJ, Pisani D. et al. Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am 2007; 32: 119-123
• 13 del Piñal F. Dry arthroscopy and its applications. Hand Clin 2011; 27: 335-345
• 14 Illarramendi AA, Shcultz C, De Carli P. The surgical treatment of Kienböck’s disease by radius and ulna metaphyseal core decompression. J Hand Surg Am 2001; 26: 252-260
• 15 Dedeoğlu SS, Imren Y, Çabuk H. et al. Results of Percutaneous Fixation and Distal Radius Core Decompression in Scaphoid Waist Non-Unions Treated Without Grafting. Hand Surg Rehabil 2018; 37: 43-47
• 16 Chu PJ, Shih JT. Arthroscopically Assisted Use of Injectable Bone Graft Substitutes for Management of Scaphoid Nonunions. Arthroscopy 2011; 27: 31-37
• 17 Haugstvedt JR, Jørgsholm P, Kvernmo HB. Arthroscopy-Assisted Screw Fixation. In Scaphoid Fractures. Evidence-Based Management. Eds: Buijze G. Jupiter Elsevier; St. Louis: 2018: 151-63
• 18 Wong WYC, Ho PC. Arthroscopic Management of Scaphoid Nonunion. Hand Clinics 2019; 35: 295-313
• 19 Merrell GA, Wolfe SW, Slade III JR. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am 2002; 27: 685-691
• 20 Stark HH, Rickard TA, Zemel NP. et al. Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation. J Bone Joint Surg Am 1988; 70 A: 982-991
• 21 Finsen V, Hofstad M, Haugan H. Most scaphoid non-unions heal with bone chip grafting and Kirschner-wire fixation. Thirty-nine patients reviewed 10 years after operation. Injury 2006; 37: 854-859