Scaphoid pseudoarthrosis

Case
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.

Findings
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.

Discussion
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.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

1
Comment

avatar
1 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
1 Comment authors
Bangoura Recent comment authors
  Subscribe  
newest oldest most voted
Notify of
Bangoura
Guest
Bangoura

LA PSEUDO ARTHROSE SCAPHOIDE A UNE EVOLUTION INCIDIEUSE AU DEBUT APRES PLUSIEURS ANNEES ET MOIS ELLE DEVIENT DOULOUREUSE APRES UN NOUVEAU TRAUMATISME SOUVENT BENIN. LE POIGNET ENFLE AVEC LES MOIS ET LES ANNEES IL VA PERDRE SA MOBILITE ET SON AMPLITUDE LES DOULEURS DEVIENNENT RAPPROCHEES ET HANDICAPANTES. LA RADIOGRAPHIE L IRM LE SCANER NOUS AIDENT A METTRE EN EVIDENCE UNE EVENTUELLE FRACTURE DU SCAPHOIDE NON OU MAL TRAITEE OU UN FEBUT D ARTHROSE. LE TRAITEMENT EST LE PLUS SOUVENT CHIRURGICAL SURTOUT LORSQU IL S AGIT D UN SPORTIF DE HAUT NIVEAU ET DE SURVROIT UN GARDIEN DE BUT. L INTERVENTION… Read more »