Ununited scaphoid fracture with dorsal intercalated segment instability and scaphoid non union advanced collapse
Presentation
Scaphoid nonunion & DISI ? RS OA/ ?SNAC
Patient Data
Wrist Plain Film:There is a scaphoid non-union. Early changes of osteoarthritis are present in the radiocarpal joint with loss of cartilage and subchondral sclerosis. Lunate is tilted dorsally.
There is an un-united scaphoid waist fracture, which has formed pseudoarthrosis. There is an associated dorsal humpback deformity.
The dorsal band of the scapholunate ligament is intact, however there is an old bony avulsion at its scaphoid attachment. The central and volar portions of the scapholunate ligament are intact.
There is dorsal tilt of the lunate.
The lunato-triquetral ligament is intact.
Minor negative ulnar variance noted.
The TFC is grossly intact. Intermediate signal at the superior portion of the disc likely represents sprain.
There is moderate degenerative change at the dorsal aspect of the radio-scaphoid and radio-lunate joints, with chondral loss and subchondral sclerosis and bony spurring.
Conclusion
Scaphoid waist fracture non-union with pseudoarthrosis.
Intact SL ligament.
There are moderate degenerative changes at the radio-carpal joint, particularly dorsally. This would be in keeping with SNAC.
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