Can Any Proximal Pole Scaphoid Fracture Nonunion be Treated with Arthroscopic Bone Grafting? A Series of Case Reports of Successes in Challenging and Unique Cases.

Due to the unique morphology and tenuous vascularity, proximal pole fractures of the scaphoid are prone to nonunion if neglected. The vascular anatomy and the understanding that the blood flow to the proximal pole is retrograde in nature, has supported the concept of disruption of blood flow to the proximal pole with the possibility of avascular necrosis in a nonunited proximal pole. Historically, surgical management at this stage has favored the use of a vascularized bone graft over a nonvascularized bone graft to achieve union and good outcomes. However, the current literature seems to deviate from the long-standing understanding of proximal pole nonunion and its relationship to avascular necrosis. Not only does it state that avascular necrosis is extremely rare, but it also advocates arthroscopic bone grafting of proximal pole nonunions using morselized nonvascularized bone graft which has been proven to be a highly successful operation. Here, in our paper, we present a short series of some unique but surgically challenging cases of proximal pole nonunion and our successful management by bone grafting and fixing them arthroscopically. Our experience and invariably the experience of many may indicate that arthroscopic bone grafting and fixation may be the correct choice of surgery for proximal pole nonunion of the scaphoid bone.