Carpus

Ununited Fracture of the Proximal Pole of the Scaphoid With Avascular Necrosis

Kakar S, Shin AY (Mayo Clinic, Rochester, MN) J Hand Surg 36A:1522-1524, 2011^§

Abstract

Background

Avascular necrosis (AVN) of the proximal pole occurs in about 3% of all scaphoid fractures. Delay in diagnosis and treatment, proximal fracture, over 1   mm of displacement, and carpal malalignment may contribute to this complication. For proximal pole nonunions, vascular bone grafts are recommended, especially for those with osteonecrosis, but nonvascularized bone grafts are sometimes used.

Case Report

Man, 25, had radial-sided wrist pain for 8   months after falling off a skateboard. The patient had tenderness of the anatomical snuffbox and discomfort with radial and ulnar deviation of the wrist. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) revealed a nondisplaced nonunited fracture of the proximal pole of the scaphoid but no arthrosis. AVN was diagnosed.

Management Options

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