Ipsilateral Proximal Hamate Osteochondral Autograft for Proximal Scaphoid Pole Reconstruction: Technical Note

Abstract Scaphoid fractures, primarily those involving the proximal pole, are particularly susceptible to developing nonunion and avascular necrosis (AVN) because of the morphology and retrograde vascular supply of the scaphoid. When the proximal pole is nonviable or too small for internal fixation, reconstruction remains a significant surgical challenge. Various surgical techniques have been described in literature. However, no consensus exists on a gold standard approach. We present our surgical technique for proximal scaphoid pole reconstruction using an ipsilateral proximal hamate osteochondral autograft and our strategy for managing scapholunate stability on the basis of the pattern of nonunion according to the Garcia-Elias classification. This method provides a biological, joint-preserving alternative that avoids the need for a microsurgical vascularized graft. Ten male patients (mean age: 25.5 years) with proximal pole scaphoid nonunion underwent reconstruction between 2022 and 2024. Clinical, radiographic, and functional outcomes were assessed at a mean follow-up of 17 months. Union was achieved in all the patients within a mean of 4 months. Visual analog scale score decreased significantly (from 6.3 to 0 at rest; 7.3 to 1 under load). The Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation scores decreased from 18.1 to 3.9 and from 29.8 to 8.5, respectively. Mild reductions in wrist range of motion and grip strength were observed. No cases of nonunion or early osteoarthritis occurred. The ipsilateral proximal hamate autograft is a reliable, anatomical option for proximal scaphoid reconstruction, with encouraging clinical outcomes and low donor site morbidity.