Hamate autograft for proximal pole scaphoid fracture: A systematic review - 20/03/25

Doi : 10.1016/j.hansur.2025.102129

Zac Dragan ^a, Adam R. George ^a,⁎ , Brahman S. Sivakumar ^a,^b,^c,^d,^e
^a The University of Sydney, Sydney Medical School, Faculty of Medicine and Health, Camperdown, NSW 2050, Australia
^b Royal North Shore Hospital, Department of Hand & Peripheral Nerve Surgery, Reserve Road, St Leonards, NSW 2065, Australia
^c Australian Research Collaboration on Hands (ARCH), Suite 4/75, Railway Street, Mudgeeraba, QLD 4213, Australia
^d Hornsby Ku-ring-gai Hospital, Department of Orthopaedic Surgery, Palmerston Road, Hornsby, NSW 2077, Australia
^e Nepean Hospital, Department of Orthopaedic Surgery, Kingswood, NSW 2747, Australia

^⁎Corresponding author.

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 20 March 2025

Abstract

Background

Proximal pole scaphoid fracture is not uncommon and present therapeutic challenges due to impaired perfusion, with risk of secondary non-union, avascular necrosis and wrist degeneration. There is no consensus on surgical techniques for a non-salvageable proximal pole, but proximal hamate autograft to resurface the scaphoid is gaining interest. This systematic review assesses the evidence for proximal hamate autograft in resurfacing non-salvageable scaphoid proximal poles.

Methods

A systematic review searched the Medline, Embase, PubMed and Scopus databases for the period 2000-2024, following PRISMA guidelines. The protocol was registered with PROSPERO. Risk of bias was measured using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions).

Results

Mean duration of non-union at presentation was 50.8 months (n = 10), with a mean follow-up of 15.7 months (n = 10). Mean hamate graft length was 6.7 mm (n = 26). Radiographic union was achieved in 93.3% of patients (n = 30), at a mean 10.6 weeks (n = 26). Mean postoperative wrist flexion-extension was 89.5 ° (n = 10), averaging 61.4% of the arc for the contralateral hand (n = 8). Pronation and supination recovered contralateral values (n = 5). Postoperative grip strength in the affected hand was 79.8% of the contralateral value (n = 26). Postoperative QuickDASH score and VAS pain rating averaged 25 (n = 8) and 2 (n = 21), respectively. Five patients (16.7%; n = 30) experienced complications.

Conclusions

Hamate autografting for resurfacing non-salvageable scaphoid proximal poles demonstrated satisfactory early-to-medium-term outcomes. Although promising, more research is necessary to confirm the utility of this treatment modality.