Arthroscopic treatment of scaphoid nonunion with debridement and cancellous bone grafting before or after K-wire fixation.

Abstract

We compared the outcomes of two groups of patients with scaphoid nonunion treated with arthroscopic cancellous bone grafting. In group 1, K-wires were introduced beforehand and in group 2 after debridement and packing bone grafts in the nonunion site. Our hypothesis was that the percentage of unions would be higher in group 2. We conducted a retrospective, single-centre comparative study of two consecutive series of patients. Seventeen patients in group 1 were operated between 2011 and 2015 and 25 patients in group 2 between 2015 and 2022. At 3 months, there was already a significant difference in consolidation, with three fractures united in group 1 and 21 in group 2. At 6 months, 10 patients (59%) united in group 1 and 24 (96%) in group 2. Debridement of the nonunion site without K-wires in place may allow a more thorough debridement and extensive filling of the defect with bone graft. If an arthroscopic technique is used for scaphoid nonunion, we do not recommend prior fixation with K-wires.Level of evidence: III.