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Proximal pole scaphoid reconstruction for unsalvageable proximal scaphoid nonunions using proximal pole hamate autograft: a multi-center case series
Courtney R Carlson Strother, MD
1; Joshua J. Meaike, M.D
1; Bassem Elhassan, MD
1; Robin N Kamal, MD
2; Jeffrey Yao, MD
2; R. Glenn Gaston, MD
3; Sanjeev Kakar, MD, FAOA
41Mayo Clinic, Rochester, MN; 2Stanford University, Redwood City, CA; 3OrthoCarolina Hand Center, Charlotte, NC; 4Orthopaedics, Mayo Clinic, Rochester, MN
Introduction: Proximal pole scaphoid fracture nonunions are challenging conditions to treat. When significant comminution of the proximal pole and avascular necrosis is present, scaphoid proximal pole reconstructive options are considered. The proximal pole of the hamate is a local autograft option. However, little has been described on the outcomes of this procedure. Therefore, the purpose of this study was to evaluate the radiographic and patient reported outcomes following proximale pole hamate to scaphoid reconstruction.
Materials and Methods: Patients who underwent proximal pole scaphoid reconstruction using proximal pole hamate autograft at 3 tertiary care centers were retrospectively reviewed. Demographics, operative reports, and imaging studies were analyzed. Radiographic union was classified by >50% bony trabeculae across the reconstruction site on computed tomography scan. Patients were contacted by phone and invited to return to clinic or answer questionnaires over the phone for final analysis.
Results: Ten patients had proximal hamate to scaphoid autograft fixation for proximal pole scaphoid avascular necrosis. Average age at time of surgery was 27.9 years, and 60% were male. Average length of proximal pole autograft harvested was 10 mm. The proximal pole of the scaphoid was reconstructed using cannulated screws, and 50% of cases had temporary capitolunate pins placed for 6-8 weeks.
All patients healed at an average of 14.3 weeks following surgery. One patient underwent screw removal and arthroscopic microfracture of the capitate following proximal pole reconstruction for midcarpal pain 1.5 years postoperatively. At final follow up, 3 patients reported no pain, 3 reported mild occasional pain, 2 reported moderate tolerable pain (1 at the hamate graft site), and 2 had no reports on their pain level. Final postoperative radiographs demonstrated an average scapholunate angle of 50.1 degrees (range 39-70 degrees). On average, patients lost 4.8° of wrist flexion and gained 10.4° of wrist extension following surgery. Four of the 10 patients filled out patient reported outcomes. Average QuickDash was 3.4, and average patient-rated wrist evaluation was 11.1.
Conclusion: In small proximal pole scaphoid nonunions with fragmentation and avascular necrosis, proximal pole hamate local autograft reconstruction of the scaphoid proximal pole is a viable and reproducible option with high rates of union and patient satisfaction. Longer term follow up in a larger series of patients is needed.
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