To compare arthroscopic versus open radial-approach management of scaphoid nonunion in Schernberg zones 2 and 3, with respect to radiographic union and functional recovery.

Retrospective cohort study of 54 consecutive patients treated for scaphoid nonunion in zones 2–3 over two years: 23 by arthroscopy and 31 via an open radial approach. Primary outcome was consolidation rate on imaging. Secondary outcomes were clinical and functional recovery recorded at follow-up; 22 patients underwent standardized clinical evaluation.

Overall consolidation rate was 81% (44/54). Consolidation occurred in 21/23 (91%) arthroscopy patients and 23/31 (74%) open‑approach patients. Among the 22 patients with clinical assessment, those treated arthroscopically showed superior functional scores and range-of-motion measures. Differences did not reach statistical significance.

In this series, arthroscopic treatment of scaphoid nonunion in Schernberg zones 2–3 was associated with a higher observed consolidation rate and better functional outcomes compared with the open radial approach, although differences were not statistically significant. Arthroscopy appears to be a promising option for these nonunions and warrants further study in larger, prospective trials.