gms | German Medical Science

Objectives/Interrogation: Recently, minimally invasive techniques have been recommended in the treatment of stable scaphoid non-unions regardless of the presence of cystic formations or small contact area. The purpose of this study was to determine whether arthroscopically assisted bone grafting gave superior results in healing as compared to percutaneous screw fixation alone.

Methods: 164 consecutive patients with scaphoid non-unions were retrospectively analyzed. 148 patients were treated with the open grafting either with iliac bone or from distal radius, leaving 16 patients treated with minimally invasive techniques. The Mini Acutrac headless fully threaded compression screw system of Acumed, (Hillsboro, Oregon, USA) was used in all cases.

Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks (range 4-56 weeks). In the group treated percutaneously (n=8), the median time from injury to operative treatment was 2,3 months (range 2 - 4 months) and it was 27,3 months (range 3-180 months) in the group treated arthroscopically (n=8). All patients were male except one female in the percutaneous group. The mean age was 42,5 years in the group treated percutaneously, 22 years in the arthroscopically treated group, (range 20-66) and (range 16-32), respectively. Data were calculated with two-tailed Mann-Whitney U test based on associated p-value of p<0.05 which was considered statistically significant. All patients were investigated with the CT scan to distinguish any humpback deformity of the scaphoid bone which also was the exclusion criteria. Postoperative CT scan were performed only in cases where radiographs did not show progressive healing to avoid unnecessary exposure to radiation. The postoperative regime was identical in both groups.

Results and Conclusions: We recorded no complications in any of the groups. All patients treated arthroscopically received cancellous bone grafting from the distal radius. They healed at median of 7,8 weeks (range 5-18). 7 patients in the percutaneous group healed at mean of 10,8 weeks (range 7-24). Mann Whitney U test showed the u value of 11, the critical value of U to be 13 (p<0.05).

Arthroscopically treated patients achieved significantly faster healing, despite significantly longer time from injury to surgery. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. A larger, randomised trial between different treatment methods is desirable.