Femoral Trochlea Osteochondral Autograft Transplant for Scaphoid Proximal Pole Nonunions

Small proximal pole scaphoid nonunions are challenging to treat. We describe a technique for replacing the proximal pole fragment with an osteochondral autograft transplant harvested from the ipsilateral femoral trochlea. This is indicated in nonunions where the proximal pole fragment is smaller than the scaphoid isthmus; the scapholunate ligament complex is intact on the distal fragment, and in nonunions without dorsal intercalated segment instability and radiocarpal arthritis. The osteochondral autograft transplant is press-fitted into the distal scaphoid and does not require implants for osteointegration. This provides an advantage during revision surgery of previously fixed proximal scaphoid fractures that are not united with an implant in situ.