http://upload.orthobullets.com/topic/6051/images/case A - Stage 2 xray ap_moved.jpg
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Introduction
  • A condition caused by AVN of scaphoid
  • Epidemiology
    • rare condition
    • average age of onset is 45 years
Presentation
  • Symptoms
    • dorsoradial wrist pain
Imaging
  • Radiographs
    • show sclerosis and fragmentation of proximal pole without evidence of fracture  
  • MRI
    • can further allow classification into complete vs partial involvement  
Treatment
  • Nonoperative
    • immobilization
      • is effective in 20% of cases
  • Operative
    • microfracture drilling, revascularization procedure, or allograft replacement
      • indications
        • when nonoperative management fails
      • techniques include
        • drilling
        • revascularization
        • allograft replacements
    • proximal row carpectomy or scaphoid excision with four corner fusion
      • indications
        • considered salvage procedures

 

 

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