Clinical:
- A 54 years old man
- History of trauma few years ago
- Pain at right wrist region after the trauma
MRI findings:
- There is fracture at the scaphoid waist
- The proximal pole of fracture fragment (arrow) is small in size
- It also shows abnormal signal intensity
- The distal fracture fragment is normal in size, however irregular outline distally and cystic change within it suggestive of arthritis
- Abnormal signal in adjacent extensor carpi radialis tendon
Diagnosis: Avascular necrosis of scaphoid
Discussion:
- Scaphoid fractures are common, however can be difficult to diagnose.
- Early detection and treatment is important to prevent complication including avascular necrosis and painful arthritis
- Avascular necrosis is common in scaphoid fracture due to its peculiar blood supply
- Occurs in 15-30% of scaphoid fractures
- Almost always involves the proximal pole
- The more proximal is the fracture line, the risks of avascular necrosis increase
- The radiographic hallmarks of AVN are collapse and fragmentation
- MRI is more sensitive to detect AVN than conventional radiographs
