Scaphoid pseudoarthrosis

Case contributed by Jose Ignacio Aragon

Presentation

Wrist pain, no history of recent trauma.

Patient Data

Age: 45 years
Gender: Female
x-ray

Projections of the right hand revealed two separate segments of the scaphoid with sclerotic, regular borders in relation with scaphoid pseudoarthrosis.

Simple bone cyst in the distal scaphoid segment.

Case Discussion

The scaphoid is the most frequently injured carpal bone (60% to 70% of all carpal fractures).„ 65% of the scaphoid fractures are at the waist, 15% at the proximal pole, „ 10% at the distal body,  „8% at the tuberosity and„ 2% at the distal articular surface.

Complications of the scaphoid fractures include ostenecrosis, carpal instability, non-union and osteoarthritis.

The incidence of scaphoid nonunion is 5-15%. The nonunion is diagnosed if the fracture does not heal in 6 months.

Abnormalities of nonunited scaphoid fractures include:

  • Sclerosis of the fracture margins,
  • Cyst formation
  • Widening of the scapholunate interval
  • Bone resorption
  • Osteoarthritis.

Treatment

Nondisplaced, uncomplicated fractures are treated conservatively with immobilization and casting. Displaced fractures are treated surgically with an interfragmentary screw fixation. Symptomatic scaphoid nonunions are treated surgically with bone graft and interfragmentary screw fixation.

Differential diagnosis

  • Bipartite scaphoid

Coauthor of this case include Dr Jose R Zuniga.

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