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

Abstract

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. 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. 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). 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.