Treating a non-union in the proximal pole of the scaphoid remains one of the most significant challenges in hand and wrist surgery. When traditional fixation and standard bone grafting fail, surgeons must look toward innovative autograft techniques to restore stability and function to the carpus.
Hamate Bone Autograft Rebuilds Proximal Scaphoid
The scaphoid bone plays a critical role in wrist mechanics, acting as a bridge between the proximal and distal carpal rows. When this bone fails to heal after a fracture, the resulting non-union can lead to progressive carpal collapse and debilitating arthritis. Recent clinical reports have highlighted the success of using a proximal hamate autograft to reconstruct these complex injuries.
This specific technique is designed to address the most difficult cases, particularly those involving significant bone loss or avascular necrosis. In a featured case study, surgeons were able to achieve complete bony union within just 10 weeks. This rapid healing timeline suggests that the hamate graft provides a robust biological environment for carpal reconstruction.
Why Proximal Scaphoid Fractures Fail to Heal
The primary reason for healing failure in the proximal pole is the unique vascular anatomy of the scaphoid bone. Blood supply is largely retrograde, meaning the proximal portion relies on vessels entering at the distal end. When a fracture occurs at the pole, this blood supply is frequently severed, leading to a high risk of osteonecrosis.
Standard surgical strategies often involve internal fixation with compression screws, but these may be insufficient if the bone quality is poor. In cases where the bone has already begun to collapse or die, simple fixation cannot bridge the gap. This necessitates a more complex reconstruction that replaces the damaged tissue with viable, healthy bone.
Hamate Autograft as a Local Reconstruction Option
Traditionally, surgeons have used bone grafts from the iliac crest or the distal radius to treat non-unions. While effective, these donor sites can cause additional pain and morbidity for the patient at the harvest site. The proximal hamate autograft offers a local alternative that minimizes these secondary complications while providing a graft with similar curvature to the scaphoid.
One of the standout advantages of this technique is the ability to retain the attached volar capitohamate ligament. This ligamentous support is vital for maintaining scapholunate stability, which is often a major concern during wrist reconstruction. By preserving this connection, surgeons can better replicate the natural kinematics of the wrist joint.
Furthermore, the hamate graft acts as an osteochondral replacement, meaning it provides both the bone and the cartilage surface needed for the joint. This makes it an ideal choice for patients who have suffered significant articular damage. The local nature of the graft also ensures that the surgical field remains concentrated, potentially reducing recovery time.
Case Report and Clinical Outcome
A notable case involved a 26-year-old Air Force service member who experienced persistent pain and a lack of strength in his left wrist. Despite initial Herbert screw fixation and a subsequent revision with iliac crest bone grafting, the scaphoid failed to unite. This left the patient with limited options for a return to full duty and high-impact activity.
The surgical team decided to perform a reconstruction using the proximal hamate autograft technique to replace the non-viable proximal pole. This salvage procedure was successful, resulting in a stable construct that allowed for early range-of-motion exercises. The patient eventually achieved a pain-free state with a near-full arc of wrist motion.
Post-operative imaging confirmed that the graft had fully integrated with the remaining scaphoid bone. For a high-demand individual like a service member, this outcome represents a significant victory over a condition that often leads to permanent disability. The success of this case provides a roadmap for treating similar failures in athletic or active populations.
Clinical Takeaway for Hand and Wrist Care
The use of proximal hamate autografts represents a promising shift in the management of complex carpal non-unions. By focusing on local, anatomically similar graft sources, surgeons can improve union rates and functional outcomes. This technique is particularly valuable when osteonecrosis or significant bone loss complicates the clinical picture.
Clinicians should consider this approach for patients who have failed multiple prior surgeries or those with proximal pole injuries. While the procedure requires precise technical execution, the biological advantages of the hamate graft are clear. Future studies may further define the long-term durability of this reconstruction compared to vascularized bone grafts.
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Rheumatology
Hamate Bone Autograft Rebuilds Proximal Scaphoid
Hamate Bone Autograft Rebuilds Proximal Scaphoid
18 Feb 2026
Rheumatology
View All News
PROXIMAL hamate autograft reconstructed a proximal scaphoid non-union after recurrent fixation, achieving union within 10.0 weeks.
Scaphoid fractures are the most common carpal fractures and often follow a fall on an outstretched hand. Proximal pole injuries are especially challenging because retrograde blood supply increases the risk of non-union and osteonecrosis. In this case report, surgeons describe a reconstruction approach for complex proximal pole non-unions associated with collapse, bone loss, and suspected osteonecrosis, where standard strategies may be less reliable.
Traditional surgical management of proximal pole non-union may involve vascularized bone grafting or non-vascularized bone grafting, with donor sites such as the iliac crest or distal radius. The featured technique uses a proximal hamate autograft as an osteochondral replacement arthroplasty for the proximal scaphoid pole. The report highlights a potential advantage of retaining the attached volar capitohamate ligament, which may support reconstruction where scapholunate stability is a concern, while also offering a local graft option intended to limit donor site morbidity.
A 26-year-old Air Force service member presented with persistent left wrist pain and difficulty lifting after a proximal scaphoid fracture. Initial management with Herbert screw fixation resulted in non-union. After 6 months, revision surgery was performed using iliac crest bone grafting with Kirschner wire fixation, but non-union persisted. The surgical team then used the proximal hamate autograft technique to reconstruct the proximal scaphoid pole.
The authors report union within 10 weeks and a pain free, near full wrist arc, suggesting this proximal hamate autograft technique may be a promising option for select patients with proximal pole scaphoid non-union complicated by bone loss and osteonecrosis.
Reference: Kumar A et al. Proximal Hamate Autograft in Non-union Proximal Scaphoid Fractures, A Novel Technique – A Case Report. J Orthop Case Rep. 2026;16(2):121–125. doi:10.13107/jocr.2026.v16.i02.6768.
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
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Copyright © 2026 European Medical Group LTD trading as European Medical Journal. All rights reserved. European Medical Journal is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations.
This site is intended for healthcare professionals
Home
Rheumatology
Hamate Bone Autograft Rebuilds Proximal Scaphoid
Hamate Bone Autograft Rebuilds Proximal Scaphoid
18 Feb 2026
Rheumatology
View All News
PROXIMAL hamate autograft reconstructed a proximal scaphoid non-union after recurrent fixation, achieving union within 10.0 weeks.
Scaphoid fractures are the most common carpal fractures and often follow a fall on an outstretched hand. Proximal pole injuries are especially challenging because retrograde blood supply increases the risk of non-union and osteonecrosis. In this case report, surgeons describe a reconstruction approach for complex proximal pole non-unions associated with collapse, bone loss, and suspected osteonecrosis, where standard strategies may be less reliable.
Traditional surgical management of proximal pole non-union may involve vascularized bone grafting or non-vascularized bone grafting, with donor sites such as the iliac crest or distal radius. The featured technique uses a proximal hamate autograft as an osteochondral replacement arthroplasty for the proximal scaphoid pole. The report highlights a potential advantage of retaining the attached volar capitohamate ligament, which may support reconstruction where scapholunate stability is a concern, while also offering a local graft option intended to limit donor site morbidity.
A 26-year-old Air Force service member presented with persistent left wrist pain and difficulty lifting after a proximal scaphoid fracture. Initial management with Herbert screw fixation resulted in non-union. After 6 months, revision surgery was performed using iliac crest bone grafting with Kirschner wire fixation, but non-union persisted. The surgical team then used the proximal hamate autograft technique to reconstruct the proximal scaphoid pole.
The authors report union within 10 weeks and a pain free, near full wrist arc, suggesting this proximal hamate autograft technique may be a promising option for select patients with proximal pole scaphoid non-union complicated by bone loss and osteonecrosis.
Reference: Kumar A et al. Proximal Hamate Autograft in Non-union Proximal Scaphoid Fractures, A Novel Technique – A Case Report. J Orthop Case Rep. 2026;16(2):121–125. doi:10.13107/jocr.2026.v16.i02.6768.
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
FAQ
What is a proximal hamate autograft for scaphoid non-union? It is a surgical technique where a small piece of the hamate bone is harvested from the patient’s own wrist to replace a non-healing or necrotic proximal pole of the scaphoid bone, restoring joint congruity and stability.
Why do proximal scaphoid fractures have a high rate of non-union? The scaphoid has a retrograde blood supply, meaning blood enters from the distal end. A fracture at the proximal pole often cuts off this supply, leading to avascular necrosis (bone death) and failure to heal.
What are the advantages of using hamate bone over iliac crest grafts? The hamate autograft is a local source, reducing donor site morbidity. It also provides a natural curvature and articular cartilage that closely mimics the scaphoid’s anatomy, which iliac crest bone cannot provide.
How long does it take for a hamate autograft to heal? Clinical case studies have shown that complete bony union can be achieved in as little as 10 weeks, allowing for a faster return to range-of-motion exercises compared to traditional grafting methods.
Advancements in orthopedic grafting continue to provide new solutions for difficult carpal injuries. To stay updated on the latest surgical techniques and case studies in rheumatology and hand care, subscribe to our clinical newsletter today.
