A 17-year-old male goalkeeper fell onto his outstretched hand (FOOSH) causing a hyperextension force to his left wrist. He was diagnosed with a scaphoid fracture and was managed in a thumb spika cast for 8 weeks with regular follow-up x-rays. He was able to return to play 4 weeks later.
Eight months after his successful return to play, the player returned following a second injury. He reported a forced extension injury while blocking a ball. He complained of generalised wrist pain. On examination his range of motion was almost normal (a 10-15º loss of both extension and flexion) and there was no tenderness in snuff-box fossa.
The x-ray images taken at the time of the initial injury show an undisplaced fracture of the medial third of the scaphoid. Subsequent MRI images show increased signal within the whole scaphoid bone with sclerotic fracture margins.
This player was treated surgically with internal fixation combined with bone grafting from the iliac crest. He was able to return to play three months later without any ongoing complaints.
Scaphoid pseudoarthrosis is distinguished from acute fractures through both a player’s history (time elapsed since the injury) and radiological findings (fracture resorption, sclerotic fracture margins, cystic change and increasing displacement). Atypical injury mechanisms like non-FOOSH injuries, the lack of specific scaphoid tenderness and relatively high functionality following the initial injury may also make one consider the possibility of a pseudoarthrosis.
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