Olecranon Bone Autografting Combined with an Arthroscopic Approach for the Treatment Scaphoid Nonunion - An Important Technique for Wrist Surgeons.

Effective treatment of scaphoid pseudoarthrosis is critical to reduce the risk of progression to the potentially debilitating scaphoid nonunion advanced collapse including complications of persistent wrist joint instability, degenerative arthritis, decreased range of motion, chronic pain, and functional impairment. Both anatomic and fracture-related pathophysiology predispose patients to scaphoid nonunion, including limited retrograde blood flow, fracture location, and delay of appropriate treatment. Recent studies have demonstrated successful outcomes in treatment of scaphoid nonunions, with non-vascularized bone autograft, commonly from distal radius or iliac crest, as well as pedicled vascularized or free vascularized autograft with union rates varying from 84% to 100%. However, these surgical treatment options require large dissection, prompting a focused interest in minimally invasive arthroscopic options. Theoretically, minimally invasive technique mitigates against devitalizing scaphoid fracture fragments as well as damage to structures such as the joint capsule, ligaments, and already highly tenuous blood supply. Use of olecranon bone graft in combination with a minimally invasive arthroscopic technique and screw fixation is a reasonable option to minimize devitalizing the scaphoid fracture fragments and minimize damage to important soft-tissue structures.