Proximal Hamate Autograft in Non-union Proximal Scaphoid Fractures, A Novel Technique - A Case Report

Scaphoid is the most common carpal to be fractured (60%), caused by fall on outstretched hand, and proximal pole fractures are difficult to manage due to the high risk of non-union and osteonecrosis due to retrograde blood supply. Conservative management of proximal pole fractures leads to high rates of non-union; hence, different surgical techniques have been devised to address bone loss and optimize vascularity at fracture site to promote healing, such as vascularized bone grafting (VBG) and non-VBG. We report the use of proximal hamate as a replacement arthroplasty in the context of proximal pole non-unions with collapse, bone loss, and/or osteonecrosis as an innovative approach.

A 26-year-old Air Force personnel presented with left wrist pain and difficulty in movement and lifting. He had a fall on an outstretched hand causing a proximal scaphoid fracture, initially treated with Herbert screw fixation, resulting in non-union. A revision surgery with iliac crest bone grafting and Kirschner wire fixation was performed after 6 months, but non-union persisted.

This novel surgical technique of using proximal hamate autograft for reconstruction of osteonecrosis proximal pole of scaphoid has shown promising result with union within 10 weeks and good functional outcome with pain-free near full wrist arc.