Arthroscopic Bone Graft and Internal Fixation of Non-Union of the Proximal Pole of the Scaphoid: Surgical Technique and Outcomes

Ecker, Jeff FAOrthA, FRACS, MBBS, BMedSc
Shahbaz, Laiba BSc
Kohli, Sukhsimran BSc
Breidahl, William MBBS, MRCP, FRANZCR
Andrijich, Courtney BSc MA

¹ Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
² Hand and Upper Limb Centre, Claremont, Western Australia, Australia
³ Perth Radiological Clinic, Subiaco, Western Australia, Australia

Address for correspondence Courtney Andrijich, BSc, MA, Jeff Ecker Clinic, Bethesda Hospital, 25 Queenslea Drive, Claremont 6010, WA, Australia (e-mail: [email protected]).

received July 19, 2021

accepted November 17, 2021

published online January 20, 2022

Journal of Wrist Surgery 11(6):p 535-540, December 2022. | DOI: 10.1055/s-0041-1742097

Abstract

Background

Fractures of the proximal pole of the scaphoid have been associated with delayed union, non-union, and avascular necrosis. This has been attributed to avascularity of the proximal pole of the scaphoid. While proximal pole non-unions can be successfully treated using open techniques, there is little information in the literature regarding arthroscopic bone graft and internal fixation of proximal pole non-unions.

Description of Technique

After insertion of a 1.2-mm radiolunate K-wire, the scaphoid non-union was arthroscopically excised, bone grafted with iliac crest cancellous bone, and internally fixed with 3 × 1.2 mm K-wires.

Patients and Methods

This is a retrospective study of patients who had arthroscopic bone graft of non-union of the proximal pole of the scaphoid between 2009 and 2021.

Results

There were 30 cases in this study; 29 cases united. The one case that did not unite was caused by inadequate fixation of the proximal pole. The size of the proximal pole did not influence the outcome.

Conclusion

Arthroscopic bone graft and internal fixation is a reliable technique for the treatment of non-union of the proximal pole of the scaphoid.