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