Avascular necrosis of scaphoid

Case contributed by Varun Babu
Diagnosis almost certain


Volar wrist swelling for evaluation.

Patient Data

Age: 40 years
Gender: Male

Fracture of waist of scaphoid with increased density of proximal pole. Irregular articular margin of distal radius. Normal other carpal bones. 

Chronic fracture of waist of scaphoid. Secondary sclerosis and reduced volume of proximal pole due to infarction. Areas of margin irregularity seen involving the distal pole as well as volar margin of radial component of radiocarpal joint. A ganglion cyst is seen lying in the volar aspect of radial styloid. Focal osteodegenerative changes seen in capitohamate articulation as well as in distal margin of lunate. 

Case Discussion

The scaphoid receives blood supply from the distal branches of radial artery, primarily to the mid and distal poles. The proximal pole receives retrograde blood supply. The peculiar blood supply of the scaphoid means, on the slightest hint of vascular compromise, the proximal pole is most susceptible to ischemia. The fracture in this instance enables the vascular compromise to happen. 

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