Arthroscopic Treatment of Scaphoid Nonunion with Nonvascularized Autogenous Bone Grafting: A Prospective Study of 39 Patients

Purpose To evaluate the clinical and radiological outcomes of all-arthroscopic curettage and nonvascularized autogenous bone grafting for the treatment of established scaphoid nonunion. Methods Since 2023, 39 consecutive patients (mean age 29.3 years) with scaphoid nonunion were prospectively enrolled. Nonunion was classified according to the Schernberg system: zone 1 in 3 cases (8%), zone 2 in 7 (18%), zone 3 in 24 (62%), and zone 4 in 5 (13%). No humpback deformity was observed. Smoking status was documented: 26 nonsmokers (67%) and 13 smokers (33%). Surgery was performed at a mean of 13.4 months after injury. Bone graft was harvested from the distal radius (mean volume ∼0.8 mL per procedure) and delivered arthroscopically via midcarpal portals. Osteosynthesis was achieved with crossed Kirschner wires (1.5 mm [0.059 in] and 1.2 mm [0,047 in]) in 95% of cases. Results Union was achieved in 37 of 39 patients (94.8%) at a mean of 4.85 months. All united patients returned to professional activities. No avascular necrosis, tendon, or nerve injury was recorded. Functional assessment in 22 patients at ≥12 months yielded a mean Quick DASH (Disabilities of the Arm, Shoulder, and Hand)-inspired score of 12.5 out of 100. Smokers had higher scores (22.3) compared with nonsmokers (8.0). Conclusions Arthroscopic bone grafting for scaphoid nonunion yields results comparable to open techniques with reduced soft tissue morbidity. Smoking was associated with worse functional outcomes without preventing union in this series. The technique represents a reliable minimally invasive alternative in appropriately selected patients. Type of study/level of evidence Therapeutic III.