A 25-year-old man has a radiograph of the wrist after a fall showing a fracture through the waist of the scaphoid. He is initially treated in a cast. Six months later, a follow-up radiograph shows a sclerotic proximal pole of the scaphoid with mild collapse. What complication has occurred?

• A Malunion of the fracture
• B Reflex sympathetic dystrophy
• C Carpal tunnel syndrome
• D Avascular necrosis of the proximal fragment ✓

Explanation

The blood supply to the scaphoid enters distally and flows proximally, making the proximal pole vulnerable to avascular necrosis after a waist fracture, which interrupts this retrograde supply. Radiographically, AVN presents as increased density (sclerosis) of the proximal fragment due to failure of revascularization and subsequent bone death with collapse. This is a well-recognized complication occurring in up to 30% of scaphoid waist fractures. MRI is more sensitive for early detection before radiographic changes appear.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.