Management of Failed Proximal Scaphoid Replacement with Osteochondral Rib Autograft – Case Report

Background: Proximal pole scaphoid fractures pose a complex surgical challenge. Fractures proximal to the vessels entering the dorso-radial surface can result in avascular necrosis (AVN) due to ischemia of the proximal pole. Management of these types of fractures can be difficult due to the delayed presentation of patients. Surgical management is limited when the proximal pole is deemed unreconstructible. Viable options for young, non-arthritic patients include vascularised or non-vascularised bone grafting. Additionally, an adaptive proximal scaphoid implant with a pyrocarbon implant has also been shown to provide adequate outcomes. This case highlights a patient who had a failed pyrocarbon implant and then went on to have a successful non-vascularised rib autograft procedure. Case report: A 22-year-old male athlete presented with a proximal pole scaphoid fracture. He suffered a hyper-extension injury to his wrist 3 years previous to his presentation. The patient subsequently developed AVN and underwent proximal pole pyrocarbon replacement. This replacement failed due to excessive early mobilisation. The following revision procedure involved incorporating an osteochondral rib autograft. 4 months later the patient was pain-free and returned to previous high-level activity. At 1 year follow-up, he had a Patient Rated Wrist Evaluation score of 6.5/100 with full range of motion. Conclusion: Osteochondral rib graft is a viable option for the management of failed proximal scaphoid replacement failure and provides good functional outcomes in a young active patient.