Updated: 5/20/2021

Preiser's Disease (Scaphoid AVN)

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  • Summary
    • Preiser's Disease is a condition caused by avascular necrosis of the scaphoid which can lead to progressive radial-sided wrist pain.
    • Diagnosis can be made with wrist radiographs showing sclerosis and fragmentation of the proximal pole of the scaphoid without evidence of fracture.
    • Treatment is NSAIDs and observation in minimally symptomatic patients. A variety of operative procedures are available depending on severity of disease and patient's symptoms.
  • Epidemiology
    • Incidence
      • rare 
        • < 1 per 100,000 annually
    • Demographics
      • 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
  • Diagnosis
    • Radiographic 
      • diagnosis confirmed by history, physical exam, and radiographs
  • Treatment
    • Nonoperative
      • NSAIDs, 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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