Abstract
Due to the unique morphology and tenuous vascularity, proximal pole fractures of the
scaphoid are prone to nonunion if neglected. The vascular anatomy and the understanding
that the blood flow to the proximal pole is retrograde in nature, has supported the
concept of disruption of blood flow to the proximal pole with the possibility of avascular
necrosis in a nonunited proximal pole. Historically, surgical management at this stage
has favored the use of a vascularized bone graft over a nonvascularized bone graft
to achieve union and good outcomes. However, the current literature seems to deviate
from the long-standing understanding of proximal pole nonunion and its relationship
to avascular necrosis. Not only does it state that avascular necrosis is extremely
rare, but it also advocates arthroscopic bone grafting of proximal pole nonunions
using morselized nonvascularized bone graft which has been proven to be a highly successful
operation. Here, in our paper, we present a short series of some unique but surgically
challenging cases of proximal pole nonunion and our successful management by bone
grafting and fixing them arthroscopically. Our experience and invariably the experience
of many may indicate that arthroscopic bone grafting and fixation may be the correct
choice of surgery for proximal pole nonunion of the scaphoid bone.
Keywords arthroscopy - bone graft - proximal pole - nonunion
