{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T16:10:13Z","timestamp":1769098213976,"version":"3.49.0"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Scaphoid fractures are the most frequent fractures of carpal bones, accounting for 70 to 80% of all carpal fractures. Appropriate and early diagnosis of scaphoid fractures is imperative.<\/jats:p>\n                  <jats:p>To relieve symptoms and prevent degenerative changes, scaphoid non-union surgery should aim at healing and restoration of the normal anatomy, and correction of carpal deformities.<\/jats:p>\n                  <jats:p>Since the scaphoid non-unions are a heterogeneous group, and categorization is not easy, the management remains controversial with a reported failure rate as high as 40% and the absence of a \u201cgold standard\u201d treatment.<\/jats:p>\n                  <jats:p>Based on (a) Qu and Von Schroeder's new concepts on the osteogenic ability of the non-union cells stimulated by osteoinductive bone factors; (b) the encouraging results obtained by Illarramedi et al on decompression of the distal radius and ulna in Ki\u00ebnbock disease treatment; and (c) along with the minimal surgical trauma of percutaneous and arthroscopic techniques, the authors have begun treating scaphoid non-unions without bone graft by using arthroscopic-assisted reduction and internal fixation with metaphyseal core decompression of the distal radius. The technique has also been used in advanced cases with \u201chumpback\u201d deformity and long-standing non-unions. Resting on the observations of CT scans and arthroscopic findings, we have introduced a new comprehensive classification of scaphoid non-union for better categorization and typification and provide an improved treatment approach. We recommend arthroscopic-assisted treatment in young and middle-aged non-smoking patients with scaphoid non-unions. Percutaneous fixation alone is sufficient for stable stages I and II, whereas additional core decompression of the distal radius can be used for unstable stages, for bone defects greater than 10\u2009mm, and for the proximal pole non-unions. This method is not suggested in non-unions with significant sclerosis, with a complete absence of punctate bleeding of the proximal pole, and in those with a very small proximal fragment.<\/jats:p>","DOI":"10.1055\/s-0044-1800948","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T19:10:51Z","timestamp":1739905851000},"page":"024-034","source":"Crossref","is-referenced-by-count":0,"title":["Scaphoid Non-union Arthroscopic Treatment without Bone Graft: Is it Possible?"],"prefix":"10.1055","volume":"15","author":[{"given":"Martin F.","family":"Caloia","sequence":"additional","affiliation":[{"name":"Upper Extremity and Hand Surgery Section, Orthopaedic Department, Austral University Hospital, School of Medicine, Austral University, Buenos Aires, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9729-0926","authenticated-orcid":false,"given":"Maria F.","family":"Bozoghlian","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Surgery Service, Orthopedics and Rehabilitation Department, University of Iowa, Iowa City, Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gonz\u00e1lez S.","family":"Diego","sequence":"additional","affiliation":[{"name":"Upper Extremity and Hand Surgery Section, Orthopaedic Department, Austral University Hospital, Buenos Aires, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego L.","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Bern University, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"key":"ref1","volume-title":"The wrist: diagnosis and operative treatment","author":"W P Cooney","year":"2010"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s12178-011-9072-0","article-title":"Assessment of scaphoid fracture healing","volume":"4","author":"L A Hackney","year":"2011","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S0749-0712(21)01437-2","article-title":"Incidence, mechanism, and natural history of scaphoid fractures","volume":"17","author":"S H Kozin","year":"2001","journal-title":"Hand Clin"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"483","DOI":"10.2106\/00004623-200104000-00001","article-title":"Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures","volume":"83","author":"C D Bond","year":"2001","journal-title":"J Bone Joint Surg Am"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jcot.2021.03.003","article-title":"A systematic review of mechanical stabilization by screw fixation without bone grafting in the management of stable scaphoid non-union","volume":"17","author":"L Elgayar","year":"2021","journal-title":"J Clin Orthop Trauma"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1302\/0301-620X.89B5.18183","article-title":"The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid","volume":"89","author":"C Ramamurthy","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1177\/17531934231158992","article-title":"Vascularized versus non-vascularized bone grafting for scaphoid nonunion without avascular necrosis: a randomized clinical trial","volume":"48","author":"S Fan","year":"2023","journal-title":"J Hand Surg Eur Vol"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/j.jhsa.2015.05.003","article-title":"Treatment of scaphoid nonunion: a systematic review of the existing evidence","volume":"40","author":"R M Pinder","year":"2015","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1177\/1753193408090122","article-title":"The osteogenic potential of pseudoarthrosis tissue and bone from human scaphoid non-unions","volume":"33","author":"G Qu","year":"2008","journal-title":"J Hand Surg Eur Vol"},{"issue":"445","key":"ref10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/01.blo.0000205886.66081.9d","article-title":"Minimally invasive management of scaphoid nonunions","volume":"445","author":"J F Slade III","year":"2006","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1053\/jhsu.2001.22928","article-title":"The surgical treatment of Kienb\u00f6ck's disease by radius and ulna metaphyseal core decompression","volume":"26","author":"A A Illarramendi","year":"2001","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.arthro.2008.01.003","article-title":"Incidence of ligamentous and other injuries associated with scaphoid fractures during arthroscopically assisted reduction and percutaneous fixation","volume":"24","author":"M F Caloia","year":"2008","journal-title":"Arthroscopy"},{"issue":"445","key":"ref13","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/01.blo.0000205886.66081.9d","article-title":"Minimally invasive management of scaphoid nonunions","volume":"445","author":"J F Slade III","year":"2006","journal-title":"Clin Orthop Relat Res"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1302\/0301-620X.93B7.25418","article-title":"Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss","volume":"93","author":"M Mahmoud","year":"2011","journal-title":"J Bone Joint Surg Br"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"103294","DOI":"10.1016\/j.otsr.2022.103294","article-title":"Correction of residual humpback deformity after arthroscopic treatment of scaphoid non-union","volume":"108","author":"A De Bie","year":"2022","journal-title":"Orthop Traumatol Surg Res"},{"issue":"04","key":"ref16","first-page":"216","article-title":"Arthroscopic reconstruction for unstable scaphoid non-union","volume":"61","author":"P J Delgado-Serrano","year":"2017","journal-title":"Rev Esp Cir Ortop Traumatol"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0736-0266(01)00142-5","article-title":"Human atrophic fracture non-unions are not avascular","volume":"20","author":"A A Reed","year":"2002","journal-title":"J Orthop Res"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1302\/0301-620X.66B1.6693468","article-title":"Management of the fractured scaphoid using a new bone screw","volume":"66","author":"T J Herbert","year":"1984","journal-title":"J Bone Joint Surg Br"},{"key":"ref19","first-page":"175","volume-title":"Chapter 22: Percutaneous fixation of scaphoid fibrous\/nonunion with and without percutaneous bone graft","author":"J F Slade III","year":"2011"},{"issue":"08","key":"ref20","first-page":"714","article-title":"Fractures and pseudarthroses of the carpal scaphoid. The various stages of pseudarthrosis [in French]","volume":"74","author":"J Y Alnot","year":"1988","journal-title":"Rev Chir Orthop Repar Appar Mot"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0266-7681(95)80036-0","article-title":"The issue of vascularity in fractures and nonunion of the scaphoid","volume":"20","author":"U B\u00fcchler","year":"1995","journal-title":"J Hand Surg Br"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.hcl.2013.09.002","article-title":"Use of arthroscopy for the treatment of scaphoid fractures","volume":"30","author":"D J Slutsky","year":"2014","journal-title":"Hand Clin"},{"key":"ref23","first-page":"21","article-title":"Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach","author":"J F Slade 3rd","year":"2002","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"031","DOI":"10.1055\/s-0040-1712089","article-title":"Arthroscopic treatment of scaphoid pseudoarthrosis without bone graft: is it really feasible?","volume":"48","author":"M F Caloia","year":"2020","journal-title":"Revista Iberoamericana de Cirug\u00eda de la Mano"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1142\/S2424835518300049","article-title":"Surgical strategy for scaphoid nonunion treatment","volume":"23","author":"J H Yeo","year":"2018","journal-title":"J Hand Surg Asian Pac Vol"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0266-7681(97)80051-4","article-title":"Experience with scaphoid grafting","volume":"22","author":"N J Barton","year":"1997","journal-title":"J Hand Surg [Br]"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1302\/0301-620X.83B6.0830809","article-title":"Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium","volume":"83","author":"J S Dawson","year":"2001","journal-title":"J Bone Joint Surg Br"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1053\/jhsu.2002.33197","article-title":"The relationship between proximal pole blood flow and the subjective assessment of increased density of the proximal pole in acute scaphoid fractures","volume":"27","author":"N D Downing","year":"2002","journal-title":"J Hand Surg Am"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1302\/0301-620X.90B7.20371","article-title":"Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months","volume":"90","author":"J J Dias","year":"2008","journal-title":"J Bone Joint Surg Br"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S0363-5023(86)80141-1","article-title":"Percutaneous pinning of symptomatic scaphoid nonunions","volume":"11","author":"M Q Cosio","year":"1986","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s11420-009-9129-4","article-title":"Vascular endothelial growth factor: an essential component of angiogenesis and fracture healing","volume":"6","author":"B Beamer","year":"2010","journal-title":"HSS J"},{"key":"ref32","first-page":"15","article-title":"Risk factors for the development of persistent scaphoid non-union after surgery for an established non-union","author":"E D Patterson","year":"2024","journal-title":"Hand (N Y)"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1177\/1753193419841253","article-title":"Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting","volume":"44","author":"B Liu","year":"2019","journal-title":"J Hand Surg Eur Vol"}],"container-title":["Journal of Wrist Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1800948.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T23:34:26Z","timestamp":1769038466000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1800948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,18]]},"references-count":33,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,21]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1800948","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2163-3916","2163-3924"],"issn-type":[{"value":"2163-3916","type":"print"},{"value":"2163-3924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,18]]}}}