Scaphoid non union advanced collapse

Case contributed by Dr Eric F Greif


Persistent wrist pain 3 months after surgery

Patient Data

Age: 40 years
Gender: Male

There is a nonunited scaphoid fracture with a bridging screw. The radioscaphoid and scaphocapitate joint space is narrowed with lucency in the radial styloid and capitate suggesting degenerative subchondral cyst formation. There is some sparing of the radiolunate joint. There is also marked narrowing of the joint between the capitate and lunate with sclerotic changes. The collective findings are consistent with scaphoid non union advanced collapse (SNAC).

Patient is status post proximal row carpectomy, with removal of the scaphoid, lunate, and triquetrum. There is re-demonstration of degenerative sclerotic and cystic changes to the radial styloid and capitate. There is interval articulation between the radius and capitate with new degenerative changes compared to prior study.

Case Discussion

Patient presented with stage 3 scaphoid non union advanced collapse  (SNAC wrist). Subsequently the patient was surgically treated with a proximal row carpectomy. Three months post operation the patient continued to complain of wrist pain.

There is a know higher failure rate (of pain relief) with proximal row carpectomy when there is severe degenerative changes involving the lunocapitate (stage 3 SNAC) prior to surgery 1. Therefore, radiologist need to be vigilant and make an early diagnosis.

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