Topographical Analysis of the Hamate for Proximal Pole Scaphoid Nonunion Reconstruction

Abstract

Purpose: To quantify the similarity of the surface topography of the proximal hamate and proximal pole of the scaphoid for nonunion reconstruction.

Methods: Using previously acquired computed tomographic scans of the wrist of 10 patients, the 2 bones were segmented and subsequently aligned using both a manual and automated technique. Surface error between corresponding articular surfaces was computed to determine the similarity of the shape of the 2 bones.

Results: The median distance between the 2 articulating surfaces for each patient was 1 mm or less for all cases. Maximum distance varied from 2.7 to 9.7 mm. The automated method improved alignment such that the maximum distance was 4.1 mm. Visual review of the alignment revealed that the maximum error occurred on or around the margin of the articulating surfaces.

Conclusions: In most cases, the proximal hamate appears to be a suitable donor match to reconstruct proximal pole scaphoid nonunions.

Clinical relevance: This study serves as a guide to practitioners when considering the suitability of the proximal hamate autograft for unsalvageable proximal pole scaphoid nonunions.

Keywords: Fragmented scaphoid fractures; hamate osteotomy; proximal pole fractures of the scaphoid with avascular necrosis; scaphoid nonunion.