Scaphoid avascular necrosis (contrast-enhanced MRI)

Case contributed by Henry Knipe
Diagnosis almost certain


Chronic wrist pain post injury 6 months prior.

Patient Data

Age: 25 years
Gender: Male

Non-united scaphoid waist fracture. Within the proximal fracture fragment adjacent to the fracture line is a T1 hypointense, T2 hyperintense region bordered by a low T2 rim that does not enhance. The remainder of the proximal fracture fragment shows a similar enhancement to the distal fracture fragment. 

Comment: Approximately 25% avascular necrosis of the scaphoid proximal fracture fragment. 

Case Discussion

Contrast-enhanced MRI has been shown to correlate well with intra-operative vascularity of the scaphoid, however, this appears independent from the success of scaphoid non-union surgery. 

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