Scaphoid nonunion with humpback deformity

Case contributed by Bahman Rasuli
Diagnosis almost certain

Presentation

Fall onto a hyperextended hand, delay in seeking treatment.

Patient Data

Age: 45 years
Gender: Male
  • scaphoid waist nonunion fracture associated with pseudoarthrosis and early degenerative changes

  • volar subluxation of the distal scaphoid fragment resulting in a secondary humpback-type deformity

  • T1 marrow signal of the proximal pole of the scaphoid is consistent with scaphoid viability

  • the scapholunate ligament is normal

  • the lunate is dorsally tilted associated with increased capitolunate angle measuring about 44o (normal <30o) and scapholunate angle¬†measuring about 98o (normal <60o) suggesting dorsal intercalated segment instability (DISI)

  • the extensor carpi ulnaris (ECU) tendon demonstrates medial palmar subluxation from its fibro-osseous tunnel

  • there is a fluid containing structure next to the ulnar styloid having a narrow tail connected to the ulno-carpal joint

  • there is also abnormal signal intensity at the triangular fibrocartilage suggesting ligamentous injury

Case Discussion

Imaging findings are consistent with the scaphoid waist chronic fracture with pseudoarthrosis and humpback deformity. Normal T1 marrow signal in the proximal scaphoid pole with no collapse or significant sclerosis is a useful marker in assessing scaphoid viability, but it is not always 100% specific.

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