Background: Scaphoid fracture nonunion is a troublesome complication that if untreated will led to avascular necrosis of proximal pole then carpal collapse and degenerative arthritis. The proximal pole of the scaphoid vascular status is an important factor in determining the type of bone graft used whether vascularized or non-vascularized.
The purpose of this study was to evaluate the results of a new technique in the reconstruction of proximal pole scaphoid fractures nonunion with avascular necrosis by using proximal Hamate as an autograft to restore the shape of scaphoid and scapholunate mechanics and the effect of graft size on wrist mechanics.
Patients and methods : This was an interrupted time series clinical trial (quasi experimental) study, that included twenty patients with non-united proximal scaphoid fractures with avascular necrosis of the proximal part treated with excision of the proximal pole of scaphoid and reconstruct with the proximal pole of Hamate and repair scapho-lunate ligament.
Results: All fractures united except two fractures , with a mean period of 10.2 weeks , a mean follow up period was 11 months , there was an improvement in VAS score from 8 (7-9) preoperative to 2 (0-5) post-operative and final Mayo wrist score was 93.1(range 79-98).
Conclusion: The use of proximal hamate as an autograft to reconstruct the proximal osteocartilaginous surface of the scaphoid nonunited fractures with AVN of the proximal pole is a promising technique.
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