gms | German Medical Science

Objectives/Interrogation: In the treatment of scaphoid nonunion, the aim of arthroscopy is to reduce risk and operative duration, shorten recovery and immobilization time and improve bone healing, preserving vascularity as much as possible and makes the procedure safer and more accurate.

The aim of this presentation is to analyze our results with this innovative treatment and to compare it with similar clinical cases that underwent open treatment in our institution.

Methods: Fifty four patients with scaphoid non-union were treated in our hospital from 2009 to 2017.

In the open group (n= 25), patients were treated with open reduction, debridement, cortico-cancelous bone graft from distal radius and fixation with a compression screw.

Arthro group (n= 29), were treated arthroscopically with focus debridement, distal radius cancellous graft when needed, and fixation with compression screw.

Post-operatively patients have the same protocol and were kept in a plaster for 4 weeks followed by splint for another 4 weeks, and they underwent hand therapy beginning at 6-8 weeks.

All the patients were revised at the final follow-up using the Modified Mayo Hand score, Visual analogue scale and radiological assessment in AP and profile

Results and Conclusions: Average age and male/female ratio of the patients in both groups were similar (Open: 35 years (19-69) and M:F ratio 14:2, Arthro: 28 years (20-61) and M:F ratio 14:1).

We lost three patients (12%)in open group and two patients (6% )in arthro group to follow-up.

In open group 20 patients (81%) achieved radiological union at an average follow up of 26 weeks (16-32). All patients but three (81%) achieved good functional outcome at mean follow up of 52 weeks (32-74).

In Arthro group, 27 patients (89%) achieved radiological union, at an average follow up of 17 weeks (16-27). At 52 weeks all patients but two, with proximal pole non-union, achieved good functional outcome.

The average final Mayo score was 78,3 in the Open group and 92,3 in the Arthro group.

There was a better range of movement in group B (mean F/E 55-0-50) comparatively with group A (mean F/E 47-0-39).

Arthroscopic treatment of scaphoid nonunions seems to bring a better functional outcome with shorter time to reach consolidation compared with the open treatment.

Both techniques present similar consolidation rates after one year.

Even if arthroscopy is a difficult technique, with a long learning curve,we believe arthroscopic treatment of scaphoid nonunions should be provided to patients if possible.