The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Mohammad Ali Okhovatpour 1
Reza Zandi 1
Ahmadreza Ahmadi Abdashti 2
Meisam Jafari kafiabadi 3
1 Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran
2 Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22038/abjs.2024.79732.3644
Abstract
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.
 Level of evidence: IV
Keywords
Arthroplasty
Nonunion
Proximal scaphoid pole fracture
Reconstruction
Scaphoid fracture
Subjects
  1. Ko JH, Pet MA, Khouri JS, Hammert WC. Management of Scaphoid Fractures. Plast Reconstr Surg. 2017; 140(2):333e-346e. doi: 10.1097/PRS.0000000000003558.
  2. Spit SA, Becker SJE, Hageman M, Ring D. The Prevalence of Unanticipated Hamate Hook Abnormalities in Computed Tomography Scans: A Retrospective Study. Arch Bone Jt Surg. 2017; 5(3):133-138.
  3. Large TM, Adams MR, Loeffler BJ, Gardner MJ. Posttraumatic Avascular Necrosis after Proximal Femur, Proximal Humerus, Talar Neck, and Scaphoid Fractures. J Am Acad Orthop Surg. 2019; 27(21):794-805. doi: 10.5435/JAAOS-D-18-00225.
  4. Klifto CS, Ramme AJ, Sapienza A, Paksima N. Scaphoid Nonunions. Bull Hosp Jt Dis (2013). 2018; 76(1):27-32.
  5. Grewal R, Lutz K, MacDermid JC, Suh N. Proximal Pole Scaphoid Fractures: A Computed Tomographic Assessment of Outcomes. J Hand Surg Am. 2016; 41(1):54-8. doi: 10.1016/j.jhsa.2015.10.013.
  6. Rodriguez-Merchan EC, Tabeayo-Alvarez ED, Shojaie B, Kachooei AR. Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes. Arch Bone Jt Surg. 2023; 11(3):144-153. doi: 10.22038/ABJS.2022.65875.3154.
  7. Wong K, von Schroeder HP. Delays and poor management of scaphoid fractures: factors contributing to nonunion. J Hand Surg Am. 2011; 36(9):1471-4. doi: 10.1016/j.jhsa.2011.06.016.
  8. Sgromolo NM, Rhee PC. The Role of Vascularized Bone Grafting in Scaphoid Nonunion. Hand Clin. 2019; 35(3):315-322. doi: 10.1016/j.hcl.2019.03.004.
  9. Rancy SK, Schmidle G, Wolfe SW. Does Anyone Need a Vascularized Graft? Hand Clin. 2019; 35(3):323-344. doi: 10.1016/j.hcl.2019.03.005.
  10. Matsuki H, Ishikawa J, Iwasaki N, Uchiyama S, Minami A, Kato H. Nonvascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion. J Orthop Sci. 2011; 16(6):749-55. doi: 10.1007/s00776-011-0158-8.
  11. Elhassan B, Noureldin M, Kakar S. Proximal Scaphoid Pole Reconstruction Utilizing Ipsilateral Proximal Hamate Autograft. Hand (N Y). 2016; 11(4):495-499. doi: 10.1177/1558944716628497.
  12. Chan AHW, Elhassan BT, Suh N. The Use of the Proximal Hamate as an Autograft for Proximal Pole Scaphoid Fractures: Clinical Outcomes and Biomechanical Implications. Hand Clin. 2019; 35(3):287-294. doi: 10.1016/j.hcl.2019.03.007.
  13. Wu K, Padmore C, Lalone E, Suh N. An Anthropometric Assessment of the Proximal Hamate Autograft for Scaphoid Proximal Pole Reconstruction. J Hand Surg Am. 2019; 44(1):60.e1-60.e8. doi: 10.1016/j.jhsa.2018.04.021.
  14. Burnier M, Awada T, Marin Braun F, Rostoucher P, Ninou M, Erhard L. Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts. J Hand Surg Eur Vol. 2017; 42(2):188-193. doi: 10.1177/1753193416671886.
  15. Sandow MJ. Costo-osteochondral grafts in the wrist. Tech Hand up Extrem Surg. 2001; 5(3):165-72. doi: 10.1097/00130911-200109000-00008.
  16. Zechmann-Mueller NA, Collocott S, Heiss-Dunlop W. Costo-osteochondral graft (rib graft) reconstruction of the irreparable proximal scaphoid. J Hand Surg Eur Vol. 2020; 45(7):693-699. doi: 10.1177/1753193420922786.
  17. Kamrani RS, Zanjani LO, Nabian MH. Suture anchor fixation for scaphoid nonunions with small proximal fragments: report of 11 cases. J Hand Surg Am. 2014; 39(8):1494-9. doi: 10.1016/j.jhsa.2014.05.020.
  18. Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013; 38(4):690-700. doi: 10.1016/j.jhsa.2013.01.036.
  19. Jones DB, Jr., Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010; 125(4):1176-1184. doi: 10.1097/PRS.0b013e3181d1808c.
  20. Kuhlmann JN, Mimoun M, Boabighi A, Baux S. Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid. J Hand Surg Br. 1987; 12(2):203-10. doi: 10.1016/0266-7681_87_90014-3.
  21. Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am. 1991; 16(3):474-8. doi: 10.1016/0363-5023(91)90017-6.
  22. Mathoulin C, Haerle M. Vascularized bone graft from the palmar carpal artery for treatment of scaphoid nonunion. J Hand Surg Br. 1998; 23(3):318-23. doi: 10.1016/s0266-7681(98)80049-1.
  23. Kawamura K, Chung KC. Treatment of scaphoid fractures and nonunions. J Hand Surg Am. 2008; 33(6):988-97. doi: 10.1016/j.jhsa.2008.04.026.

 

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 2
February 2025
Pages 82-86

  • Receive Date 06 May 2024
  • Revise Date 14 October 2024
  • Accept Date 09 September 2024