Arthroscopic Versus Open Bone Grafting and Internal Fixation of Scaphoid Nonunion-A Systematic Review.

Background: Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion. Methods: A review protocol was established according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed/Medline, Cochrane, Embase, and Google Scholar were searched for articles on open and arthroscopic bone grafting for scaphoid nonunion with a minimum 12 month follow-up. The primary outcome was union rates in the two techniques. Secondary outcomes were changes in pain scores, complications, functional outcomes using different scoring systems, grip strength, range of motion at the wrist, and radiological parameters for restoring normal carpal alignment. Results: Forty studies reporting on 1534 wrists were included (1152 open, 382 arthroscopic). The union rate was 93.4% and 93.2% with open and arthroscopic techniques, respectively. The functional scores were comparable between the two techniques. All patients had a reduction in their pain scores. The radiological outcome parameters were not reported by any of the studies in the arthroscopic group. Conclusion: While bone grafting with both open and arthroscopic techniques for scaphoid nonunion showed comparable union rates and functional scores, further research is needed to assess the radiological outcomes of the arthroscopic technique.