Non-repairable Scaphoid Proximal Pole Nonunion Reconstruction by Hamate Arthroplasty: A Case Series Study.

Objectives: Non-repairable scaphoid proximal pole nonunion remains a major challenge. Various reconstructive surgical approaches have been introduced, but each one has some limitations, including microvascular anastomosis, donor site morbidities, and the risk of compromising the scapholunate ligament.

Methods: This prospective interventional case series was performed on five patients. The patients underwent reconstructive surgery using proximal hamate arthroplasty by a single surgeon and were followed up for at least 12 months.

Results: All patients were male and the median age was 28, and the median follow-up time was 24 months. The median Mayo score was 70, and the DASH score was 0 (no disability) in 3 patients and 15 in two patients. The median of postoperative grip strength in the operated hands was 37.3 kg (Range 36.1-39) and in the opposite hands was 42.5 kg (Range 40-45.9). However, there were significant differences between grip strength between operated and opposite hands (P value= 0.008). A reduction of 11.1% and 15% was shown in postoperative flexion and extension compared with preoperative flexion and extension (P value = 0.194, P value = 0.102).

Conclusion: Hamate arthroplasty for nonunion of the scaphoid proximal pole appears to be a viable surgical option with favorable outcomes in terms of union rates, functional recovery, and patient satisfaction.