Base of Hamate as a reconstruction for proximal pole scaphoid fractures

Abstract

Background Scaphoid fracture nonunion is a troublesome complication that if untreated will lead to avascular necrosis (AVN) of proximal pole, then carpal collapse, and degenerative arthritis. The proximal pole of the scaphoid vascular status is an important factor in determining the type of bone graft used whether vascularized or nonvascularized. The purpose of this study was to evaluate the results of a new technique in the reconstruction of AVN proximal pole scaphoid fracture nonunion by using proximal Hamate as an autograft to restore the shape of scaphoid and scapholunate mechanics and the effect of graft size on wrist mechanics. Patients and methods This was an interrupted time-series clinical trial (quasi-experimental) study that included 20 patients with nonunited proximal scaphoid fractures with AVN of the proximal part treated with excision of the proximal pole of scaphoid and reconstruct with the proximal pole of Hamate and reconstruction of scapholunate ligament. Results All fractures united, except two fractures, with a mean period of 10.2 weeks, the mean follow-up period was 11 months, there was an improvement in visual analog scale score from 8 (7–9) preoperative to 2 (0–5) postoperative and the final Mayo wrist score was 93.1 (range, 79–98). Conclusion The use of proximal hamate as an autograft to reconstruct the proximal osteocartilaginous surface of the scaphoid nonunited fractures with AVN of the proximal pole is a promising technique.