gms | German Medical Science

Objectives/Interrogation: To present our experience of arthroscopic assisted reconstruction in patients with unstable scaphoid non-union using cancellous non-structural graft and internal fixation with headless screw.

Methods: A case series of patients with chronic unstable scaphoid non-union treated with dry arthroscopic reconstruction using two midcarpal portals. DISI was corrected with a temporary Kw throught the dorsal radius. Scaphoid defect was packed with cancellous bone graft from the distal radius across the radial-midcarpal portal. Internal fixation was performed using a mini-Acutrak or HCS headless screw. Fusion rates, radiographic and clinical evaluation was performed, with a mean prospective follow-up of 16,8 (12-36) months. All patiens were treated by the same surgeon.

Results: 32 patients with 26 (18-45) years mean age were treated. All cases showed "humpback deformity" in preoperative radiological/TC scan study. Consolidation rate was 95% (30/32) at mean 7 (4-10) weeks. Range of flexo-extension arc improved after surgery, from 138,4º to 165º. Scapholunate angle (SLA) and radio-lunate angle (RLA) was significantly improved: SLA 67,7º to 47º; RLA 30,8º to 4º. Functional postoperative evaluation: mean DASH-questionnaire was 8 and VAS (0-10) 0,7. Two cases were reoperated due to non-union: 1 case using arthroscopic cancellous bone graft again and the other patient using a 1,2 ICSRA vascularised bone graft. All cases consolidated and no reoperations was needed after the second surgical technique.

Conclusions: Arthroscopic reconstruction can be a useful alternative for chronic unstable scaphoid nonunion. In our experience presents good clinical and radiological results in scaphoid non-union with humpback deformity using a non-structural bone graft. Probably is limited for restoration of the normal carpal alignment but has positive effects on clinical wrist function recovery with comparable results to open techniques.