Scaphoid fracture with AVN

Case contributed by Dr Paul Heyworth

Presentation

Persisting left wrist and anatomical snuff box pain 8 weeks after FOOSH. A plain x-ray was unremarkable at the time of injury (not available).

Patient Data

Age: 25 years
Gender: Female
X-ray

X-ray

Minimally displaced scaphoid proximal waist fracture with central lucency. Increased sclerosis is seen on the scaphoid view of the proximal pole of the scaphoid. No widening of the scapholunate interval. No loss of scaphoid height.

CT

CT

CT of the left wrist demonstrates minimally-displaced scaphoid waist fracture with increased sclerosis of the proximal pole. No widening of the scapholunate interval. Subtle lucent line through the pisiform may represent an undisplaced fracture.

Case Discussion

Scaphoid fracture key points:

  • most common carpal bone fractured
  • 10% of scaphoid fractures have an associated fracture of another bone
  • 70% involve the waist, 10-20% the distal pole, and 5-10% the proximal pole

Avascular necrosis of the scaphoid key points:

  • occurs in 15-30% of scaphoid fractures
  • almost always involves the proximal pole
  • up to 30% of scaphoid fractures may display increased density of the proximal pole
  • the more proximal the fracture, the higher the risk of AVN
  • the radiographic hallmarks of AVN are collapse and fragmentation
  • often reversible
  • may be due to relative ischemia of the proximal pole
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Case information

rID: 60395
Published: 20th May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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