Scaphoid non-union advanced collapse and dorsal intercalated segment instability
Presentation
Wrist pain with a remote history of trauma.
Patient Data
Non-united fracture of the scaphoid waist which has formed pseudoarthrosis associated with angulation and impaction of proximal and distal parts and resulting in dorsal humpback deformity
Normal bone marrow signal in the proximal scaphoid pole without evidence of significant collapse or sclerosis suggestive of scaphoid viability
Intraosseous degenerative cystic changes at the proximal and distal poles
The proximal scaphoid part remains in contact with the lunate with no dissociation
Associated osteoarthritic changes as narrowed joint space, subchondral oedema, and cystic changes between the scaphoid proximal pole and radial scaphoid fossa consistent with stage I scaphoid nonunion advanced collapse (SNAC)
The lunate bone appears dorsiflexed in the sagittal view consistent with dorsal intercalated segmental instability (DISI).
Case Discussion
T1 bone marrow signal is a useful sequence in the assessment of scaphoid viability but it is not always specific
This is a case of scaphoid fracture complicated by nonunion, DISI, and SNAC.
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