Posttraumatic osteonecrosis and nonunion of distal pole of scaphoid

Abstract

Posttraumatic osteonecrosis of distal pole of scaphoid is an extremely rare with only two reported cases so far. We present a case of a 30-year-old male with a 2-year-old posttraumatic osteonecrosis and nonunion of distal pole of scaphoid left wrist. He presented with complaints of pain and restriction of movements. There was no evidence of radiocarpal arthritis. He was managed with open reduction and internal fixation with k-wires, supplemented by a pronator quadratus based muscle pedicle bone graft. The fracture union was achieved at 6 months. After 2 years, he had almost complete range of wrist motion and had returned to his preinjury level of functional activity. His MRI (magnetic resonance imaging) scans showed evidence of revascularization suggesting successful incorporation of bone graft.

Reconstruction of Scaphoid Non-Union and Total Scaphoid Avascular Necrosis in a Pediatric Patient: A Case Report

“…In this case, both the proximal and distal poles had developed AVN. Although AVN is typically isolated to the proximal pole when it occurs after a scaphoid fracture, there are three reports in the literature that describe AVN of the distal scaphoid pole [10, 27, 39]. In addition, there is a single report of scaphoid AVN involving both the proximal and distal poles [20], as was the case in our patient.…”

“…4 The graft bled readily after harvest, prior to division of its pedicle Fig. 5 Lateral and ulnar deviation radiographs obtained at 8 months post-operatively demonstrating the fully incorporated bone graft three reports in the literature that describe AVN of the distal scaphoid pole [10,27,39]. In addition, there is a single report of scaphoid AVN involving both the proximal and distal poles [20], as was the case in our patient.…”

“…Only a few cases of distal pole AVN or total scaphoid AVN have been reported [10,20,27,39]. We present a case of chronic scaphoid non-union with total scaphoid AVN in a skeletally immature patient, treated successfully with a free vascularized MFC graft.…”

“…The scaphoid is the most commonly fractured carpal bone and is prone to non-union and avascular necrosis (AVN), particularly when the fracture involves the proximal pole [2, 3, 6, 9, 11, 17, 30, 31, 36, 40]. Only a few cases of distal pole AVN or total scaphoid AVN have been reported [10, 20, 27, 39]. We present a case of chronic scaphoid non-union with total scaphoid AVN in a skeletally immature patient, treated successfully with a free vascularized MFC graft.…”

Distal scaphoid resection arthroplasty for treatment of avascular necrosis of the distal pole secondary to scaphoid nonunion

“…There are only a few published papers reporting on posttraumatic osteonecrosis of the distal pole of scaphoid (Kapoor et al, 2013; Sherman et al, 1983). The aim of this study was to evaluate the clinical and radiographic results of treatment of distal scaphoid avascular necrosis (AVN) following nonunion with distal scaphoid resection.…”