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Scaphoid Fx Nonunion in 25M
HPI
The patient presented to an outside surgeon's office 6 months after falling onto an outstretched wrist while playing sports. This was his first visit to a physician. After his initial injury, the patient continued to do pushups and athletic activity. The outside surgeon initially obtained wrist XRs which demonstrated a proximal 1/3rd scaphoid fracture with sclerosis of the proximal pole. The outside surgeon obtained an MRI which showed some potential dysvascular changes in the proximal pole with cystic changes at the fracture site. The outside surgeon treated the patient with open reduction internal fixation with demineralized bone matrix (DBX). The patient went on to non-union after the initial attempt at fixation.
PMH
Healthy, no tobacco use.
PE
The patient had tenderness in his anatomic snuff-box as well as volarly, over his tubercle. He had wrist extension to 40 degrees and flexion to 50 degrees.
A Medial Femoral Trochlea bone transfer was performed to reconstruct the proximal pole of the scaphoid.
