Presentation
Wrist pain with a remote history of trauma.
Patient Data
The CT study shows a non-united fracture of the scaphoid waist with associated angulation and impaction of proximal and distal parts and resulting in dorsal humpback deformity.
The proximal scaphoid part appears sclerotic consistent with avascular necrosis.
The proximal scaphoid part remains in contact with the lunate with no dissociation. Associated advanced osteoarthritis is seen between the scaphoid and radial scaphoid fossa, scaphocapitate, and lunocapitate especially dorsally, characterized by marginal osteophytes, narrowed joint space, and large pseudocysts of the lunate and radius. Multiple loose bodies are noted.
The lunate bone appears dorsiflexed in the sagittal view consistent with dorsal intercalated segmental instability (DISI).
These findings are consistent with stage III scaphoid non-union advanced collapse (SNAC).
Scaphotrapeziotrapezoid (triscaphe joint) osteoarthritis is additionally noted.
The MR study shows a non-united fracture of the scaphoid waist with associated angulation and impaction of proximal and distal parts and resulting in dorsal humpback deformity (best seen on the sagittal plane).
The proximal scaphoid pole elicits abnormal low T1 and low T2 signal intensity, consistent with avascular necrosis.
The proximal scaphoid part remains in contact with the lunate with no dissociation. Associated advanced osteoarthritis is seen between the scaphoid and radial scaphoid fossa, scaphocapitate, and lunocapitate especially dorsally, characterized by marginal osteophytes, narrowed joint space, and large pseudocysts of the lunate and radius. A small joint effusion is also noted.
The lunate bone appears dorsiflexed in the sagittal view consistent with dorsal intercalated segmental instability (DISI).
These findings are consistent with stage III scaphoid non-union advanced collapse (SNAC).
Scaphotrapeziotrapezoid (triscaphe joint) osteoarthritis is additionally noted.
Case Discussion
This is a case of a scaphoid fracture complicated by non-union, avascular necrosis, DISI, and SNAC.
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