Proximal Scaphoid Pole Reconstruction Utilizing Ipsilateral Proximal Hamate Autograft

Abstract

Background: Fractures of the proximal pole of the scaphoid can be difficult to heal because of its limited vascular supply. Furthermore, nonunion with avascular necrosis and secondary fragmentation makes surgical reconstruction a challenging procedure. Method: We describe a technique and report the outcome of a proximal hamate autograft to treat a proximal pole scaphoid nonunion with avascular necrosis. Results: At 3.5 years post reconstruction, the patient remains asymptomatic with union of his scaphoid reconstruction without any evidence of scapholunate instability. Conclusion: Proximal hamate autograft is a useful technique for addressing proximal pole scaphoid nonunions with avascular necrosis.

Keywords: avascularity; ipsilateral proximal hamate autograft; nonunion; proximal scaphoid pole fracture.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

A radiograph of the left wrist taken at the initial presentation showing evidence of a sclerotic un-united proximal scaphoid pole with a compression screw in situ.

Figure 2.

Preoperative CT scan images: (a) coronal view and (b and c) sagittal views of the left wrist showing fragmentation of the proximal pole of the scaphoid. Note. CT, computed tomography.

Figure 3.

An intraoperative photograph showing the left hamate bone with osteotomy performed on the proximal 10 mm.

Figure 4.

An intraoperative photograph showing the harvested proximal hamate autograft bone with the volar capitohamate ligament that was utilized for reconstructing the dorsal scapholunate ligament.

Figure 5.

An intraoperative photograph demonstrating the hamate autograft after opposed to the scaphoid.

Figure 6.

Intraoperative fluoroscopy showing the alignment of the reconstructed scaphoid with the compression screw and a scapholunate pin in situ.

Figure 7.

A postoperative 3-dimensional CT scan image of the left wrist taken at 2 months postoperatively demonstrates evidence of scaphoid fusion. Note. CT, computed tomography.

Figure 8.

Postoperative (a) anteroposterior and (b) lateral radiographs of the left wrist taken at 3.5 years postoperatively show evidence of scaphoid fusion.