Pulsed CO2Gas arthroscopy combined with robot-navigated screw fixation and autologous iliac grafting for scaphoid nonunion.

Background

This study evaluated a novel treatment for scaphoid nonunion combining pulsed CO2 gas arthroscopy, autologous iliac bone grafting, and robot - navigated screw fixation.

Methods

18 patients (mean age 34 ± 5 years, injury duration 19 ± 7 months) with scaphoid nonunion underwent surgery. The procedure included pulsed CO2 gas arthroscopy for improved visualization, autologous iliac bone grafting for fracture healing, and robot - navigated screw fixation for stability. Postoperative care involved immediate mobilization, electromagnetic therapy, physical therapy, and short - arm splint immobilization until union.

Results

Mean surgical time was 103 ± 35 minutes, with CO2 - assisted grafting taking 23.3 ± 6.2 minutes. Average blood loss was 80 ± 25 mL, and hospital stay was 4.0 ± 1.5 days. The scapholunate angle decreased from 61.8 ± 11.6° preoperatively to 52.9 ± 7.0° postoperatively (p < .001). Fracture union rates reached 38.9% at 2 months, 88.9% at 3 months, and 100% at 6 months. All patients had accurate screw positioning with no infections or loosening. At 6 months, mean grip strength was 36 kg, pinch strength was 9.0 kg, and the Modified Mayo Wrist Score was excellent in 15 cases and good in 3.

Conclusion

By prioritizing vascular preservation through minimally invasive optics and precision fixation, this CO2-robotic integrated approach achieved superior union rates. The paradigm shift from fluid irrigation to gas-phase visualization may redefine standards in extremity arthroscopy.