PDF icon Download PDF
J Wrist Surg
DOI: 10.1055/a-2686-0739
Special Review Article

Arthroscopic Bone Grafting in Scaphoid Nonunion

Jeffrey Justin Siu-cheong Koo 
1   Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, Hong Kong
,
Pak-cheong Ho
2   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, Hong Kong
› Author Affiliations
› Further Information
   Permissions and Reprints
Preview

Abstract

Background

Scaphoid non-union continues to be a big challenge in scaphoid fracture management. The drawbacks of conventional open techniques are damage to local vascularity and supporting ligamentous structures. The advancement of wrist arthroscopy prompted the development of arthroscopic bone grafting on scaphoid nonunion and has become the treatment of choice in many international centers nowadays.

Materials and Methods

From 1997 to 2016, 111 symptomatic scaphoid nonunion and 14 delayed union cases were being operated.

Description of Technique

Nonunion site was debrided through Midcarpal Radial (MCR) portal until healthy cancellous bone was uncovered. Scaphoid fragments were fixed with three Kirschner wires (K-wires) or cannulated screw percutaneously after correction of humpback and dorsal intercalated segment instability deformity. The bone defect was fully packed with autologous bone graft delivered through MCR portal. Early mobilization was initiated as early as 5 to 7 days after the operation. K-wires were removed under local anesthesia after clinical and radiological union was confirmed.

Results

Bone union was achieved in 14 weeks (range 6–80) and overall union rate was 90.3%. Fourteen cases failed to achieve bone union after arterial blood gas test. Poor bleeding from the proximal scaphoid fragment resulted in a less favorable union rate of 78.8% and was the only statistically significant factor that affected the bone union.

Conclusions

Arthroscopic bone grafting was a breakthrough in managing difficult scaphoid delayed and nonunion. It provides a more favorable biological environment for the nonunion to heal. This is evidenced by the high union rate and satisfactory clinical outcome.

Keywords

scaphoid fracture - nonunion - wrist arthroscopy - arthroscopic bong grafting


Publication History

Received: 03 June 2025

Accepted: 19 August 2025

Article published online:
05 September 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA