Presentation
Chronic interactable wrist pain and a remote history of wrist trauma a few months ago.
Patient Data
The scaphoid proximal pole shows abnormal bone marrow signal ( low on T1 and high on PD fs ) suggestive of avascular necrosis
Lunate bone also shows abnormal bone marrow signal ( low on T1 and high on PD fs ) suggestive of avascular necrosis
Secondary degenerative changes as subchondral edema ad cystic changes are seen at capitate and hamate bones.
TFCC central perforation associated with the fluid signal distal radioulnar joint
Effusion within the radiocarpal and intercarpal joints.
The dorsal tilt of the ulna styloid.
Case Discussion
The scaphoid fracture usually occurs due to falling on an outstretched hand, leading to the wrist joint's hyperextension. The most common site of fracture is the waist which is also associated with an increased risk of avascular necrosis of the proximal pole as the blood supply of the scaphoid traverses from distal to proximal.
This is a case of scaphoid proximal pole avascular necrosis coincidence with kienböck disease.
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