Pulsed CO ₂ Gas arthroscopy combined with robot-navigated screw fixation and autologous iliac grafting for scaphoid nonunion

<b>Background:</b> This study evaluated a novel treatment for scaphoid nonunion combining pulsed CO₂ gas arthroscopy, autologous iliac bone grafting, and robot - navigated screw fixation. <b>Methods:</b> 18 patients (mean age 34 ± 5 years, injury duration 19 ± 7 months) with scaphoid nonunion underwent surgery. The procedure included pulsed CO₂ gas arthroscopy for improved visualization, autologous iliac bone grafting for fracture healing, and robot - navigated screw fixation for stability. Postoperative care involved immediate mobilization, electromagnetic therapy, physical therapy, and short - arm splint immobilization until union. <b>Results:</b> Mean surgical time was 103 ± 35 minutes, with CO₂ - assisted grafting taking 23.3 ± 6.2 minutes. Average blood loss was 80 ± 25 mL, and hospital stay was 4.0 ± 1.5 days. The scapholunate angle decreased from 61.8 ± 11.6° preoperatively to 52.9 ± 7.0° postoperatively (<i>p</i> < .001). Fracture union rates reached 38.9% at 2 months, 88.9% at 3 months, and 100% at 6 months. All patients had accurate screw positioning with no infections or loosening. At 6 months, mean grip strength was 36 kg, pinch strength was 9.0 kg, and the Modified Mayo Wrist Score was excellent in 15 cases and good in 3. <b>Conclusion:</b> By prioritizing vascular preservation through minimally invasive optics and precision fixation, this CO₂-robotic integrated approach achieved superior union rates. The paradigm shift from fluid irrigation to gas-phase visualization may redefine standards in extremity arthroscopy.