Hamate autograft for proximal pole scaphoid fracture: A systematic review

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. LEVEL OF EVIDENCE: IV (systematic review).