Scaphoid fracture non-union

Case contributed by Andrew Lawson
Diagnosis certain


FOOSH, delay in seeking treatment.

Patient Data

Age: 20 years
Gender: Male

Lucency and displaced bony fragment through waist of scaphoid.

F/U after several weeks.


There is a chronic non-union of a waist scaphoid fracture with cystic change along the fracture margins and a hump back deformity. Irregularity of the distal pole of the scaphoid laterally may be due to a further previous impaction injury.


The fracture line through the waist of the scaphoid is again demonstrated with volar subluxation of the distal scaphoid fragment resulting in a secondary humpback type deformity. Chronic non-union has resulted in pseudo-arthrosis at the level of the waist. T2 marrow edema in the proximal pole of the scaphoid is consistent with scaphoid viability. Focal T1 low signal along the distal scaphoid pole is consistent with either early degenerative change or results from a previous fracture. The scapholunate ligament and alignment are normal. The TFCC complex is intact.

Comment Chronic waist of scaphoid fracture pseudoarthrosis with humpback deformity. Normal marrow signal in the proximal scaphoid pole with no collapse or significant sclerosis which are findings consistent with scaphoid viability.

Case Discussion

T1 marrow signal is a useful marker in assessing scaphoid viability, but it is not always 100% specific.

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