Treatment Of Scaphoid Nonunion Research Articles

Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review

AbstractThe purpose of the study was to investigate whether arthroscopic treatment of carpal scaphoid nonunions by osteosynthesis with bone grafting represents a successful surgical technique. This systematic literature review, conducted following the PRISMA guidelines, explores the past 10 years of clinical studies concerning the arthroscopic treatment of scaphoid nonunions. The most relevant keywords were used to search the databases, and the Downs and Black 27-item checklist has been used as quality assessment tool. Twelve papers that meet the premised eligibility criteria have been identified. These studies demonstrate the efficacy of this surgical solution, achieving a postoperative union rate of 96% in the average time of 13.5 weeks. Regardless of the method of synthesis and the origin of the graft used, excellent results were obtained. Patients who underwent this procedure reported a pain reduction of almost 80% compared to the preoperative level, improvement in grip strength close to 40%, and recovery in wrist function during daily activities. Arthroscopy has numerous advantages compared to the open approach. These are technically recognized by the surgeon and by the patient. Some disadvantages include a longer intraoperative time and considerable significant technical difficulty. Arthroscopic treatment of scaphoid nonunion by osteosynthesis with bone graft achieves a 96% union rate of the treated scaphoid with satisfying clinical results.

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Abstract Background The optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union. Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims. Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures. Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score. Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.

Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction.

Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.

Arthroscopically-assisted scaphoid nonunion treatment. Case series with short-term results

Arthroscopically-assisted scaphoid nonunion treatment. Case series with short-term results

Arthroscopic Bone Grafting and Robot-assisted Fixation for Scaphoid Nonunion.

Scaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot-assisted fixation for the treatment of scaphoid nonunions. Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)-wires or a headless compression screw using a robotic navigation system. Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K-wires. All the guidewires were placed with a single-attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow-up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient-rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients. Arthroscopic bone grafting with robot-assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single-attempt using a robotic navigation system.

Scaphoid fracture non-union: a systematic review ofthearthroscopic management.

There is no consensus regarding the most appropriate treatment of scaphoid nonunion. This systematic review aimed to investigate whether wrist arthroscopy exerts a positive influence on bone union and clinical outcomes. We searched the literature on Medline (PubMed), Web of Science, Embase and Scopus databases using the combined keywords "scaphoid" AND "arthroscopy" AND "pseudoarthrosis" OR "nonunion". Eighteen studies were finally included in our review. The quality of the studies was assessed using the Coleman Methodological Score. Our systematic review has shown that arthroscopic management of scaphoid nonunion achieves a high rate of union and satisfactory clinical outcomes with minimal complications. There is need to perform randomized controlled trials reporting on the use of arthroscopy. In addition, the different pattern of pseudoarthrosis should be better classified to manage the patients who will benefit after the management.

Vascularized pronator quadratus pedicled bone grafting versus iliac crest bone grafting in the treatment of scaphoid nonunion: a retrospective study

Background: Vascularized pronator quadratus pedicled bone grafting is a viable procedure for the treatment of scaphoid nonunion. However, its superiority over iliac crest bone grafting is unknown. In this study, we compare the union rate and outcomes of these procedures in the treatment of scaphoid nonunion. Methods: The medical profiles of the patients with scaphoid nonunion that were treated with either pronator quadratus pedicled bone grafting (n=23) or iliac crest bone grafting procedure (n=31) were retrospectively reviewed. Patients with avascular necrosis of the scaphoid and those with the involvement of the proximal pole were excluded. The outcome measures were the union rate and time, active wrist range of motion, pinch, and grip strength. Results: The mean age of the patients was 30±8.1 yr. Bony union was achieved in all patients of the study groups. The mean time to union was 9.1±2.8 wk in the pronator quadratus group and 8.7±3.5 wk in the iliac crest groups (P=0.14). The mean active flexion, extension, radial deviation, ulnar deviation, pinch, and grip strength of the involved wrist averaged 87.3%, 86.2%, 80.2%, 89.1%, 84.3%, and 85.6% of the contralateral wrist in the pronator quadratus group and 85.5%, 87%, 77.8%, 85.1%, 88.8%, and 87.8% of the contralateral wrist in the iliac crest group, respectively. These differences were not statistically significant. Conclusion: Pronator quadratus pedicled bone grafting provides a similar union rate and outcomes compared to the iliac crest bone grafting in the treatment of scaphoid nonunion. Level of Evidence: IV

Scaphoid fracture and nonunion: new directions.

The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.

Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases.

Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors. Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported. This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5-20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN. With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics. Retrospective cohort study.

Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate.

Scaphoid is the most fractured carpal bone, with a 5-10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing. Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery. Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation. In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups. Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B. IV, case series.

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions

Abstract Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event. Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion? Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics. Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time (p = 0.028), we found no variables associated with the development of heterotopic bone formation. Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG. Level of Evidence Level II, prognostic study.

Treatment of scaphoid nonunion by arthroscopic cancellous bone grafting

IntroductionIn order to avoid Scaphoid Nonunion Advanced Collapse (SNAC) type osteoarthritis, which progressively affects the radial and midcarpal joints, several vascularized and non-vascularized grafting techniques have been described. Over the past decade, there has been growing interest in arthroscopic cancellous bone grafts for scaphoid nonunion. The aim of this novel prospective study was to assess the healing rate of scaphoid grafts under arthroscopy, and the prognostic factors for healing. Material and methodsThis prospective study was carried out across 10 centers between September 2019 and April 2021, in patients aged 16 to 65. Scaphoid nonunion grafting was performed arthroscopically. Union was assessed on CT scans and displacement correction angles were measured preoperatively and then at 3 and 6months. We assessed mobility, Jamar wrist strength, functional results as per the Patient Related Wrist Score (PRWE) and the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) score. Risk factors for nonunion were assessed. ResultsWe included 77 patients with a mean age of 24years (18 to 55years) with a mean time between trauma and treatment of nonunion of 34.8months (6 to 180months). The population was represented by 46 manual workers and 20 were smokers. In 42 cases, the nonunion was proximal, in Schernberg zone I or II. At the last follow-up of 12.9months on average (Standard Deviation: 8.7months), union was achieved in 72 patients (93.5%). The average duration of union was 3.4months (Standard Deviation 1.6). Among the 5 patients who did not heal, grafting was performed in addition to the fixation. We did not identify any contributory factors for nonunion. ConclusionThis study demonstrated the effectiveness of arthroscopic treatment of scaphoid nonunion with a union rate at least equivalent to pedicled vascularized grafts. Smoking and delayed treatment were no longer considered unfavorable prognostic factors in the context of arthroscopic treatment. Level of evidenceIII.

Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist.

In scaphoid nonunion advanced collapse (SNAC) wrist arthritis, we analyzed the 3-dimensional (3-D) deformity patterns of carpal alignment secondary to scaphoid nonunion and quantified subchondral arthritis by investigating alterations in bone density. We constructed 3-D models of the carpal bones and radius from 51 patients with scaphoid nonunion (nonunion group) and 50 healthy controls (control group). We quantified the differences in 3-D geometric position of the distal carpal row relative to the distal radius in SNAC wrists versus controls. In addition, we assessed the bone density of anatomic regions of interest in the radiocarpal and capitolunate joints relative to the pisiform bone density to characterize degenerative changes in SNAC wrists. The distal carpal row pronated by a difference of 14° (7.2° versus -6.7°; p < 0.001), deviated ulnarly by a difference of 19° (7.7° versus -11.2°; p < 0.001), shifted dorsally by a difference of 17% of the dorsovolar width of the distal radius (21.0% versus 4.4%; p < 0.001), shifted radially by a difference of 8% of the radioulnar width of the distal radius (13.2% versus 5.3%; p < 0.001), and migrated proximally by a difference of 12% of the lunate height (96.3% versus 108.8%; p < 0.001) in the nonunion group compared with the control group. Additionally, it was found that bone density was greater at the capitolunate joint (capitate head: 140.4% versus 123.7%; p < 0.001; distal lunate: 159.9% versus 146.3%; p < 0.001), the radial styloid (157.0% versus 136.3%; p < 0.001), and the radiolunate joint (proximal lunate: 134.8% versus 122.7%; p < 0.001; lunate fossa: 158.6% versus 148.1%; p = 0.005) in the nonunion group compared with the control group. Scaphoid nonunion exhibited a unique deformity pattern and alteration in bone-density distributions. The distal carpal row not only shifted dorsally and migrated proximally but also pronated, deviated ulnarly, and shifted radially. Bone density was greater at the capitolunate joint, the radial styloid, and surprisingly, the radiolunate joint. Our findings give insight into the natural history and progression of arthritis of the SNAC wrist. Additionally, future studies may give insight into whether successful treatment of scaphoid nonunion arrests the progression of arthritis. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union

Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union

Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting.

This study primarily aimed to report the outcome of the arthroscopic cancellous bone grafting technique for treating scaphoid nonunion. The secondary aim was to compare the bone union rate and time, and the ability to correct the angulation of the scaphoid, between arthroscopically treated patients (n = 27), and patients treated with open cancellous bone grafting (n = 27). Nine surgeons (two in the arthroscopic and seven in the open group) with Level III experience operated on the patients. The pain score, grip strength and Quick Disability of the Arm, Shoulder and Hand score improved significantly after the arthroscopic treatment (p = 0.0001). Arthroscopic cancellous bone grafting achieved union in 25 out of 27 patients. A retrospective comparison with open cancellous bone grafting showed four nonunions. Arthroscopically treated patients healed 5.4 weeks faster compared with the open group (p = 0.033). Patients treated with open grafting had a higher risk of failure (odds ratio = 2.17), although this was not found significant (p = 0.39). The open method corrected the angulation deformity better (dorsal cortical angle correction of 4°) than the arthroscopic method (dorsal cortical angle correction of 1°), but this was not statistically significant neither within the groups (p = 0.55, p = 0.87) nor postoperatively between the groups (p = 0.98). The height-to-length ratio was not different before and after the surgery for the arthroscopic group (p = 0.44) and the open group (p = 0.27), or postoperatively between the groups (p = 0.44).Level of evidence: III.

Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation.

Background Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation. Question What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation? Patients and Methods Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review. Range of motion, strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were obtained. Follow-up X-rays were compared with immediate postoperative X-rays. Results At a mean follow-up of 88.9 months, thumb palmar abduction and radial abduction were significantly higher on the operative side ( p = 0.28 and 0.49, respectively). Extension/flexion arc was significantly lower in the operative wrist ( p = 0.148). There was no significant difference between the operative and nonoperative sides with regard to strength. The median postoperative DASH score was 2.9 (interquartile range [IQR]: 8.3). There was no progression of osteoarthritis when immediate postoperative and follow-up X-rays were compared. Radiographic union was observed in six of the seven (85.7%) patients who were able to return to the office for follow-up radiographs. The mean scapholunate and radioscaphoid angles measured on X-rays were within normal anatomic range postoperatively. Conclusions Using nonvascularized distal radius bone graft and screw fixation in the treatment of scaphoid nonunions with associated AVN has favorable radiologic and functional outcomes and should be considered a viable treatment option for this difficult problem.

Bone Morphology and Vascular Supply of Pedicled Distal Radius Bone Using Nano-Computed Tomography.

The goal of this study was to use nano-computed tomography to describe the intraosseous vascularity and structural characteristics of commonly used distal radius vascularized bone grafts for treatment of scaphoid nonunion. We obtained 8 fresh frozen human cadaver forearm specimens for infusion of barium contrast. Specimens were scanned and segmented to quantify the vascular volume and trabecular density within 3 common graft regions, including 1, 2 intercompartmental supraretinacular artery (1,2 ICSRA), fourth extensor compartment artery (4 ECA), and volar carpal artery (VCA), as well as thirds of the scaphoid. Outcomes also included mean and maximum cortical thickness and number of cortical perforators. Single-specimen analyses were also performed comparing vascularity and trabecular density of each graft with scaphoid regions of a single specimen. Statistical analysis was performed using analysis of variance with post hoc Tukey testing when P value was less than .05. There was no significant difference between groups in the mean percent vascularity (P = .76). The ratio of trabecular bone in each graft to scaphoid thirds was less than 1. The mean cortical thickness (0.79 mm, 95% confidence interval [CI], 0.66-0.93 mm) and maximum cortical thickness (1.45 mm, 95% CI, 1.27-1.63 mm) of VCA grafts were both significantly greater than those of 4 ECA and 1,2 ICSRA (P < .001). There were no differences between vascular density of the 3 grafts and the scaphoid. Pedicled distal radius bone grafts have similar vascularity but morphometric differences such as cortical thickness and trabecular density which have unclear clinical implications.

Outcome of Scaphoid Nonunion Using Open Reduction and Internal Fixation With Iliac Crest Bone Graft (Fisk-Fernandez Technique).

Introduction The scaphoid is the most common carpal bone to be fractured and has a high propensity for nonunion. Restoration of scaphoid length mitigates the chances of long-term complications. The aim of this study was to assess the functional outcome of the Fisk-Fernandez technique for the treatment of scaphoid nonunion by using open reduction and internal fixation with trapezoidal iliac crest bone graft. Materials and methods Fisk-Fernandez technique was used to manage scaphoid nonunion in 31 patients at a tertiary care hospital with follow-up at six weeks, 12 weeks, and 24 weeks. An objective assessment of the outcome was done using a comparison of the pre- and postoperative scaphoid score, QuickDASH, and visual analogscore. Discussion The scaphoid is one of the most commoncarpal bones to get fractured. Anatomical factors, late presentation, and delay in diagnosis render it to usually land in nonunion. A comparison of the preoperative scaphoid, QuickDASH, and VAS scores with six-week, 12-week, and 24-week postoperative scores was made and was found to be statistically significant (p<0.001). Ninety-three percent of patients subjectively reported satisfaction after treatment. Though revascularization was not assessed, the bony union was observed in all the patients. Conclusion The operative technique proposed by Fisk-Fernandez is effective in correcting deformity of the scaphoid as well as providing satisfactory functional outcomes in patients with scaphoid nonunion.

The use of titanium custom-made 3D-printed prosthesis with reconstruction of scapholunate interosseous ligament in the treatment of scaphoid nonunion

article: The use of titanium custom-made 3D-printed prosthesis with reconstruction of scapholunate interosseous ligament in the treatment of scaphoid nonunion - Minerva Orthopedics 2023 February;74(1):14-9 - Minerva Medica - Journals

Outcomes after arthroscopic treatment for scaphoid nonunion using ipsilateral radius bone graft and a headless compression screw: a comparison between the patients with and without avascular necrosis.

To determine whether avascular necrosis can affect clinical outcomes or the union incidence after arthroscopic bone grafting for the treatment of scaphoid nonunion. This retrospective comparative study included thirty-four patients with scaphoid nonunion that underwent arthroscopic bone graft from the ipsilateral radius and internal fixation. The patients were divided into two cohorts (group A, with avascular necrosis, n = 15; group B, without avascular necrosis, n = 19) based on pre-operative magnetic resonance imaging findings. Additionally, the patients were grouped in accordance with the location of nonunion (waist, n = 27; proximal pole, n = 7). The mean follow-up was 20.7months (range 12.0-40.0months). Clinical outcomes, including the visual analog scale (VAS) pain score, grip strength, range of motion (ROM), Mayo Wrist Score (MWS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score, were evaluated. Radiographic measurements for carpal bone alignment were assessed as well. Union rates did not differ between groups (group A, 93.3%; group B, 94.7%: p = 0.863), and the post-operative VAS pain score, ROM, and MWS were similar at follow-up for a minimum of oneyear. DASH and grip strength were significantly better in group B, but the intergroup differences were minimal (mean DASH 11.9 versus 9.6; mean grip strength 77.5% versus 95.4% of contralateral side). There was no significant intergroup difference in mean time to achieving union (group A, 14.9weeks; group B, 14.6weeks; p = 0.900). In post-operative radiographic assessments, no significant intergroup differences were noted in any of the parameters. Subgroup analysis regarding the location of nonunion showed there were no significant intergroup differences in union rates, mean time to achieving union, and clinical outcome measures at the last post-operative follow-up. Arthroscopic bone grafting and internal fixation in the treatment of scaphoid nonunion provided good union rates and satisfactory outcomes regardless of vascularity status.