Salvaging Proximal Pole Scaphoid Nonunions Using Ipsilateral Proximal Hamate Autograft: A Multicenter Case Series.

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Proximal pole scaphoid fracture nonunions with comminution and avascular necrosis present treatment challenges.
• Reconstructive options for the proximal pole of the scaphoid are limited.
• The proximal hamate autograft is a potential local graft source, but its outcomes are not well-documented.

Purpose of the Study:

• To evaluate the outcomes of ipsilateral proximal hamate autograft reconstruction for proximal pole scaphoid nonunions.

Main Methods:

• Retrospective review of 10 patients undergoing proximal hamate autograft reconstruction at 3 tertiary care centers.
• Radiographic union assessed via CT scan, defined as >50% bony trabeculae across the reconstruction site.

Main Results:

• Ten patients (60% male, average age 27.9 years) underwent the procedure.
• Average graft length was 10 mm.
• All patients achieved radiographic union at an average of 14.3 weeks, with varying degrees of reported pain at final follow-up.

Conclusions:

• Ipsilateral proximal hamate autograft reconstruction is a viable and reproducible technique for small proximal pole scaphoid nonunions with fragmentation and avascular necrosis.
• The procedure demonstrates high rates of union.
• Patient satisfaction is generally high, with most reporting minimal to no pain.