Proximal Hamate Autograft for Scaphoid Fractures: Surgical Anatomy and Technique

Scaphoid fractures remain a surgical challenge. Due to its retrograde blood supply, proximal pole fractures in particular are at a high risk of complications including avascular necrosis and nonunion. If left untreated, negative sequelae such as total wrist arthrosis may result leaving only salvage procedures such as wrist arthrodesis as possible treatment options. There have been many techniques described to treat proximal pole scaphoid fractures by means of bone grafting from local or distant sites, each with advantages and disadvantages. The ideal choice of the donor is a balance between donor site morbidity and appropriate characteristics of bone quality, strength, and articular surface. In this chapter, we describe a technique using the ipsilateral hamate as a donor site that, in appropriately selected patients, has potential for excellent outcomes with minimal negative consequences. This method is particularly advantageous as it allows for the reconstruction of the scapholunate ligament that many other methods fail to address.