Presentation
Months of increasing wrist pain. Unspecified wrist injury 3 years ago for which no medical attention was sought
Patient Data
Chronic non-union of the scaphoid with signs of avascular necrosis, particularly of the proximal pole. The scaphoid fragments are separated and deformed with profound bone resorption, especially of the proximal pole.
Case Discussion
Scaphoid fractures are the most common carpal bone fractures. They are often difficult to spot on initial plain film examination, and a high degree of suspicion is needed in patients with clinical signs (ie with snuffbox tenderness).
The most serious complication of scaphoid fractures is avascular necrosis, which is seen in the case above. There is sclerosis around the margin on the fragments. Additionally, there is volume loss of the proximal pole.
The blood supply to the scaphoid is retrograde, traveling from the distal pole to the proximal pole. This makes the proximal pole of the scaphoid is particularly susceptible to avascular necrosis.