Clinical Outcomes Following Proximal Hamate Reconstruction of Proximal Pole Scaphoid Non-unions: A Case Series
Francisco Rodriguez Fontan, MD1; Nicholas J Tucker, MD1; Emily M Pflug, MD2; Fraser J Leversedge, MD1; Louis W. Catalano, MD1; Alexander Lauder, MD3
1University of Colorado, Aurora, CO; 2NYU Langone Health, New York, NY; 3Denver Health Medical Center, Denver, CO
Introduction: Scaphoid nonunion rates approach 10% despite adequate treatment. Small proximal pole nonunions present a clinical challenge owing to the size, compromised vascularity, and often the development of articular fragmentation. Osteochondral graft options for proximal pole reconstruction include the medial femoral trochlea or the proximal pole of the hamate. This study reports the clinical outcomes of four patients treated with proximal hamate osteochondral autograft for reconstruction of proximal scaphoid nonunion.
Materials and Methods: Institutional review board approval from the participating hospitals was obtained for this retrospective review. Primary clinical outcomes included: duration of nonunion prior to surgery, wrist and forearm range of motion (ROM), and time to radiographic union.
Results: Four patients were included with a mean age of 24 years old (range, 18-35), 3 males and 1 female. The mean interval from nonunion presentation to reconstruction was 3.9 years (range, 0.6-9). Two patients had a failed prior surgical intervention. Reconstruction with the proximal hamate and union was achieved in all cases with no complications at 11.5 weeks (range, 10 to 12). The average ROM achieved on flexion/extension and supination/pronation was 59.5% and 100%, respectively, as compared to the contralateral side (Table 1).
Conclusions: All cases achieved union of the proximal scaphoid pole reconstruction with proximal hamate osteochondral autograft. This surgical technique allows the minimal donor site morbidity, no additional incisions with no significant risk of adverse events, a sizeable graft that can be rigidly fixed to the scaphoid, no need for microvascular technique, and the harvest of the stout volar capitohamate ligament to repair the dorsal aspect of the scapholunate ligament.
| Case | Age/Sex (M/F) | Injured side (R/L) | Previous surgery | Nonunion time at presentation (months) | Type of fixation | SL stabilization/repair | Clinical follow-up (months) | Radiographic union and time to union (weeks) | ROM unaffected wrist | ROM affected wrist |
| 1 | 18/M | L | yes | 12 | Cannulated screw x2 | Repair | 11 | 12 | 90/75/80/80 | 65/57/80/80 |
| 2 | 35/M | L | yes | 108 | Cannulated screw x2 | Repair and suture anchor x1 | 3 | 10 | 80/80/80/80 | 16/34/80/80 |
| 3 | 20/M | R | no | 8 | Cannulated screw x2 | Repair and suture anchor x2 | 12 | 12 | 83/90/80/80 | 60/63/80/80 |
| 4 | 23/F | L | no | 60 | Cannulated screw x1 and K-wire x 1 | Repair and capsulodesis | 6 | 12 | 70/75/80/85 | 45/45/80/80 |
Table 1. Outlined data from case series. Note: L, left; R, right; M, male; F, female; yo, years old; SL, scapholunate; ROM, range of motion; F, flexion; E, extension; S, supination; P, pronation.
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