Abstract
Introduction Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential
concomitant pathologies that may be diagnosed and potentially managed arthroscopically.
The aim of this study is to assess the usefulness of wrist arthroscopy in the assessment
and treatment of scaphoid nonunion and any associated injuries.
Materials and Methods We retrospectively reviewed 34 consecutive patients with established scaphoid nonunion
between January 2006 and December 2012 who had undergone arthroscopic assessment.
The average age of the patients was 40 years (range: 25–64), and all the patients
had arthroscopic assessment of the wrist joint before definitive surgery. The patients
with associated intra-articular problems, which could be addressed along with the
scaphoid open reduction internal fixation (ORIF) and bone grafting (BG), had definite
procedure in the same sitting. However, if the patients had major intra-articular
pathology that needed change in the management plan, they had staged definitive treatment
after discussing with them about the arthroscopic findings.
Results Arthroscopic assessment of the 34 joints showed varying degrees of arthritis affecting
radioscaphoid joint (41%) followed by injuries to the triangular fibrocartilage complex
(TFCC) (35%), lunotriquetral ligament (LTL) tears (32%), and scapholunate ligament
(SLL) injuries (26%). Concomitant procedures performed during the wrist arthroscopy
included debridement of synovitis (62%), TFCC debridement (32%), loose body removal
(17%), and DRUJ stabilization and TFCC repair (3%). Twenty-nine patients had arthroscopy
and definitive procedure in the same sitting, and the remaining had staged or delayed
definitive treatment.
Conclusion Our study highlights the usefulness of wrist arthroscopy in assessment and management
of the scaphoid nonunion and associated pathologies. Besides in 18% of our patients,
the initial management plan changed after arthroscopy.
Level of Evidence This is a Level IV study.
Keywords
scaphoid nonunion - carpal injuries - wrist arthroscopy - wrist injuries - carpal
ligament injuries - arthritis
