Scaphoid avascular necrosis

Case contributed by Dr Craig Hacking

Presentation

2 months post FOOSH.

Patient Data

Age: 45 years
Gender: Male
X-ray

Ortho fracture clinic follow up, experiencing pain.

The scaphoid waist fracture demonstrates loss of normal alignment, with new displacement since the initial radiographs.

There is subtle new sclerosis within the proximal pole indicating evolving avascular necrosis.

X-ray

Initial radiographs at time of injury 3 month earlier

Initial radiograph 3 months prior. Subtle undisplaced scaphoid waist fracture.

Case Discussion

The scaphoid bone is the most common carpal fracture.

  • 65% of all fractures involve the waist
  • 15% proximal pole
  • 12% distal pole (more common in kids)
  • 8% tubercle

Risk of scaphoid non union and AVN is dependent on the location of the fracture, due to the retrograde dorsal arterial supply (from distal to proximal).

  • proximal pole fractures have a high risk of AVN (30%), up to 100% in proximal 1/5 fractures
  • waist fractures, uncommon
  • distal pole fractures, rare
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Case information

rID: 35209
Case created: 26th Mar 2015
Last edited: 27th Sep 2017
Inclusion in quiz mode: Included

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