Scaphoid Nonunion Advanced Collapse: Arthroscopic Debridement/Radial Styloidectomy

The patient was a 39-year-old right-hand-dominant male who presented with right wrist pain for several months. He was playing football and had a fall landing on his outstretched right hand. Previous to this, he had been diagnosed with a right scaphoid fracture 10 years ago also while playing football. This was initially treated with casting and subsequent bone stimulation. This initial fracture had gone on to nonunion and was subsequently treated with Russe bone grafting and K-wire fixation in which the patient was told the fracture healed. He noted that he had been asymptomatic for the previous 9 years after his wrist healed. At our evaluation, the patient was able to localize the pain to the radial aspect of the wrist and described it as a sharp sticking pain. In addition, he noted worsening pain with wrist extension and push-off that limited both his work and leisure activities. He complained of weakness of his hand especially when trying to hold or grip something heavy. He denied any numbness or tingling in his hand or fingers and has not had any treatment other than NSAIDs for pain.