PROXIMAL hamate autograft reconstructed a proximal scaphoid non-union after recurrent fixation, achieving union within 10.0 weeks.
Why Proximal Scaphoid Fractures Fail to Heal
Scaphoid fractures are the most common carpal fractures and often follow a fall on an outstretched hand. Proximal pole injuries are especially challenging because retrograde blood supply increases the risk of non-union and osteonecrosis. In this case report, surgeons describe a reconstruction approach for complex proximal pole non-unions associated with collapse, bone loss, and suspected osteonecrosis, where standard strategies may be less reliable.
Proximal Hamate Autograft as a Local Reconstruction Option
Traditional surgical management of proximal pole non-union may involve vascularized bone grafting or non-vascularized bone grafting, with donor sites such as the iliac crest or distal radius. The featured technique uses a proximal hamate autograft as an osteochondral replacement arthroplasty for the proximal scaphoid pole. The report highlights a potential advantage of retaining the attached volar capitohamate ligament, which may support reconstruction where scapholunate stability is a concern, while also offering a local graft option intended to limit donor site morbidity.
Case Report and Outcome
A 26-year-old Air Force service member presented with persistent left wrist pain and difficulty lifting after a proximal scaphoid fracture. Initial management with Herbert screw fixation resulted in non-union. After 6 months, revision surgery was performed using iliac crest bone grafting with Kirschner wire fixation, but non-union persisted. The surgical team then used the proximal hamate autograft technique to reconstruct the proximal scaphoid pole.
Clinical Takeaway for Hand and Wrist Care
The authors report union within 10 weeks and a pain free, near full wrist arc, suggesting this proximal hamate autograft technique may be a promising option for select patients with proximal pole scaphoid non-union complicated by bone loss and osteonecrosis.
Reference: Kumar A et al. Proximal Hamate Autograft in Non-union Proximal Scaphoid Fractures, A Novel Technique – A Case Report. J Orthop Case Rep. 2026;16(2):121–125. doi:10.13107/jocr.2026.v16.i02.6768.
