Minimally Invasive Arthroscopic Fixation of Scaphoid Nonunion in Adolescents Shows High Union Rates, Improved Function, and Low Morbidity.

PURPOSE: To evaluate the clinical, radiographic, and functional outcomes of arthroscopic treatment of scaphoid nonunion in adolescents, using cancellous bone grafting combined with headless compression screw fixation.

METHODS

This retrospective study included adolescent patients treated between 2015 and 2022 with arthroscopically assisted bone grafting and headless compression screw fixation for scaphoid nonunion. Inclusion criteria were nonunion ≥6 months after injury and minimum 12-month follow-up; exclusion criteria included degenerative wrist changes. Collected variables included demographic data, injury-to-surgery interval, radiographic parameters (including scapholunate angle), time to union, pain scores (visual analog scale), functional outcomes (QuickDASH), and range of motion. Statistical analysis showed significant improvements in visual analog scale and QuickDASH scores (P < .05).

RESULTS

Fifteen patients (14 males; mean age 16 years, range 13-19) met inclusion criteria. The mean follow-up was 29.2 months. All patients achieved bone union, with an average healing time of 5.7 weeks. Pain (visual analog scale) improved from 2.6 to 0.8, and QuickDASH scores improved from 26.5 to 7.9. The scapholunate angle improved from 60.6° to 46.6°, with stable range of motion postoperatively. No major complications or reoperations occurred. Minimal clinically important difference analysis confirmed meaningful clinical improvement in 93% of patients for pain and 87% for QuickDASH.

CONCLUSIONS

Arthroscopic treatment of scaphoid nonunion in adolescents shows high union rates, improved function, and low morbidity.

LEVEL OF EVIDENCE: Level IV, therapeutic retrospective case series.