Proximal Pole Scaphoid Fracture Nonunion Treated With Ipsilateral Hamate Transfer: A Case Series

Area of Science:

• Orthopedic surgery
• Hand surgery
• Traumatology

Background:

• The scaphoid bone's retrograde blood supply makes its proximal pole susceptible to nonunion after fracture.
• Fragmented proximal pole scaphoid nonunion presents reconstructive challenges with limited treatment consensus.
• Existing surgical options include grafts and fragment excision, with varying outcomes.

Purpose of the Study:

• To evaluate the efficacy of ipsilateral proximal hamate with volar capitohamate ligament autograft for treating proximal pole scaphoid nonunion.
• To assess functional outcomes and return-to-duty rates in a military population.

Main Methods:

• Eleven active-duty male service members with fragmented proximal pole scaphoid nonunion underwent surgical treatment.
• The procedure involved open fragment excision, internal fixation, and ipsilateral proximal hamate transfer.
• Radiographic and clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were assessed.

Main Results:

• Ten of eleven patients achieved radiographic evidence of bony union at an average follow-up of 96 weeks.
• Postoperative scapholunate (SL) widening improved significantly.
• Six patients returned to unrestricted military service, with an average DASH score of 15.7 for ten patients.

Conclusions:

• Ipsilateral proximal hamate autograft transfer is a reliable short-term treatment for proximal pole scaphoid nonunion.
• The technique results in bony union, stable SL alignment, and low disability.
• It offers an alternative with potentially lower risks compared to other reconstructive methods.