[Arthroscopic scaphoid reconstruction in non-unions : Aspects for indication, technique, and results].

BACKGROUND

Arthroscopic reconstruction of the scaphoid is a modern technique for the treatment of scaphoid non-unions. The principle is the arthroscopic resection and filling of the non-union site from the midcarpal joint space.

PROCEDURE: Through minimally invasive placement of the scaphoid screw, the critical blood supply of the scaphoid is respected, which achieves high healing rates between 90 and 100%. The use of a cancellous bone graft seems to allow for healing without carpal malalignment, even in the presence of a humpback deformity with extension malposition of the lunate, although an additional transfixation of the wrist should probably be performed. The use of cancellous bone from the distal radius end appears to have an additional healing-promoting effect due to hyperemia of the carpal bones. In the case of problems with the placement of the screw, the use of K‑wires is not detrimental to the healing rate. Particularly small proximal pole fragments can be healed by transfixation of the scapholunate joint using screws or wires.

PROGNOSIS: Ultimately, cartilage damage limited to the styloid process of the radius does not constitute a contraindication for reconstruction, provided that it is resected arthroscopically. Even if somewhat poorer clinical outcomes are to be expected, this may potentially avoid a function-compromising salvage procedure.