Our Summary

This research paper studies the outcomes of a specific type of minimally invasive surgery, called arthroscopy, in treating a condition where a small wrist bone (the scaphoid) doesn’t heal properly or in time after an injury. The study involved 25 patients who had the surgery between 8 weeks and almost a year after their injury.

During the surgery, it was found that 11 of the fractures were stable and only required a minor procedure (screw fixation); while the other 14 were less stable and needed a more complex procedure (bone grafting along with screw fixation). All of the treated fractures successfully healed.

Patients were followed up for an average of 21 months after the surgery, and it was found that they had a high level of satisfaction with the procedure (score of 96 out of 100) and very little pain or discomfort (score of 4 out of 100). The range of motion in their wrist was 90% of that in their healthy wrist.

The study concluded that arthroscopy is a useful treatment for this type of wrist injury, and helps in determining whether bone grafting is necessary. The data suggest that even when there is abnormal bone growth in the scaphoid, bone grafting isn’t always required. A simpler procedure is usually sufficient if the injury is between 8 weeks and 1 year old, without severe deformity or instability, and when the bone is found to be stable during surgery.

FAQs

  1. What is the success rate of arthroscopy in the treatment of scaphoid delayed or nonunions?
  2. When is bone grafting necessary in the treatment of scaphoid delayed or nonunions?
  3. What factors determine if percutaneous fixation alone is sufficient for treating scaphoid delayed or nonunions?

Doctor’s Tip

A helpful tip a doctor might tell a patient about wrist arthroscopy is to follow post-operative instructions carefully, including keeping the wrist elevated and applying ice to reduce swelling. It is also important to attend all follow-up appointments and participate in any recommended physical therapy to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for wrist arthroscopy include those with scaphoid delayed or nonunions, especially within 8 weeks to 1 year following injury. It is important that the patient does not have scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and that forceful probing confirms stability of the scaphoid arthroscopically. Patients with stable fractures may undergo percutaneous screw fixation only, while those with unstable fractures may require arthroscopic bone grafting in addition to percutaneous screw fixation. This procedure has shown positive outcomes in terms of fracture union, wrist function, and patient satisfaction.

Timeline

Before wrist arthroscopy:

  1. Patient experiences wrist pain, swelling, and limited range of motion.
  2. Patient undergoes imaging studies, such as X-rays and MRI, to diagnose the condition.
  3. Non-surgical treatments, such as rest, splinting, and physical therapy, may be attempted first.
  4. If conservative treatments fail, the patient may be recommended for wrist arthroscopy.

After wrist arthroscopy:

  1. The surgery is performed, either with percutaneous screw fixation only or with arthroscopic bone grafting and screw fixation.
  2. The patient undergoes a period of post-operative recovery, including physical therapy to regain strength and range of motion.
  3. Follow-up appointments are scheduled to monitor the healing process and assess outcomes.
  4. At a mean follow-up of 21 months, the patient’s wrist function is evaluated, with the Mayo wrist score and patient-rated wrist evaluation showing good outcomes.
  5. The patient may experience improved pain, range of motion, and function in the wrist following arthroscopy.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with wrist arthroscopy for delayed or nonunion of the scaphoid?
  2. How long is the recovery period after wrist arthroscopy for this condition?
  3. Will I need physical therapy or rehabilitation after the procedure?
  4. What is the success rate of wrist arthroscopy for treating delayed or nonunion of the scaphoid?
  5. Are there any alternative treatments available for my condition?
  6. How soon after the surgery can I expect to see improvements in my symptoms?
  7. Will I need any additional surgeries or procedures in the future for this condition?
  8. How experienced are you in performing wrist arthroscopy for scaphoid delayed or nonunions?
  9. What should I expect during the arthroscopy procedure?
  10. What is the long-term prognosis for my wrist after undergoing arthroscopy for this condition?

Reference

Authors: Liu B, Wu F, Ng CY. Journal: J Hand Surg Eur Vol. 2019 Jul;44(6):594-599. doi: 10.1177/1753193419841253. Epub 2019 Apr 15. PMID: 30987500