Presentation
History of old wrist trauma 10 years ago, now presented with wrist pain.
Patient Data
Scaphoid bone proximal pole non-uniform fracture showing low signal on T1 WI of its proximal pole, suggestive of avascular necrosis of its proximal pole and degenerative changes and subcortical pseudocystic changes of the opposing fracture ends.
Dorsally tilted lunate axis with increased scapholunate angle and capito-lunate angles measuring 67.8° and 35° (Normal <45° & < 30°).
Those findings are compatible with dorsal intercalated segment instability (DISI).
Degenerative changes of the radioscaphoid and to a lesser extent the intercarpal joints, evident by narrowing of the joint spaces, marrow degenerative and subcortical pseudocystic changes of their articular surfaces.
Those findings are impressive of scaphoid non union advanced collapse (SNAC).
Scaphoid proximal pole old non-united fracture with sclerosis and avascular necrosis of the proximal pole. Subchondral marrow degenerative and pseudocystic changes of the fracture ends.
Degenerative changes of the radiocarpal and intercarpal joints.
Case Discussion
Scaphoid non-union advanced collapse (SNAC) is a complication that can occur with scaphoid fractures, specifically non-union of scaphoid fractures. It is essentially the same sequela of wrist injury causing scapholunate dissociation as seen in scapholunate advanced collapse (SLAC).
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