Scaphoid non union

Case contributed by Dr Andrew Lawson

Presentation

FOOSH, delay in seeking treatment.

Patient Data

Age: 21
Gender: Male
Modality: X-ray

Lucency and displaced bony fragment through waist of scaphoid.

F/U after several weeks.

Modality: CT
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.
Modality: MRI

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 a pseudo-arthrosis at the level of the waist. T2 marrow oedema 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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Case Information

rID: 25622
Case created: 31st Oct 2013
Last edited: 1st Oct 2015
Inclusion in quiz mode: Included

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