Presentation
Increasing right wrist pain.
Patient Data
The fracture line in the scaphoid is still present. Sclerosis is noted at the fracture margins along with increased density of the proximal pole fracture fragment with cystic degenerative change.
There are chronic changes in the scaphoid with an ununited fracture through the waist.
The proximal pole is small and sclerotic, with cystic change on the volar aspect. The non cystic portion shows no marrow edema.
There is degenerative marrow edema signal in the distal scaphoid bone, with mild surrounding radioscaphoid synovitis.
The dorsal scapholunate ligament shows increased signal consistent with a chronic tear.
The lunate, distal radius, capitate show normal signal. There is minor degenerative change at the STT joint.
CONCLUSION
Chronic ununited waist of scaphoid fracture, with advanced avascular necrosis of the proximal pole and cystic change.
Case Discussion
Avascular necrosis is a well established complication of proximal pole scaphoid fractures.
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