Posts

What Exactly is Avascular Necrosis in Nonunion Scaphoid?

Vol. 9 | Issue 1 | January-February 2021 | Page: 02-07 | Anil K. Bhat, Mithun Pai. G, Ashwath M. Acharya, Sourab Shetty. S


Authors: Anil K. Bhat [1], Mithun Pai. G [1], Ashwath M. Acharya [1], Sourab Shetty. S [1]

[1] Department of Orthopaedics, Unit of Hand and Microsurgery, Kasturba Medical College, Manipal Academy of
Higher education, Manipal, Karnataka, India.

Address of Correspondence
Dr. Mithun Pai. G,
Senior Resident, Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of
Higher Education Karnataka, India.
E-mail: mithun.paig@manipal.edu

 


Abstract


Avascular necrosis or osteonecrosis is said to be higher when the fracture involves proximal one-third of the scaphoid with an incidence of 13 % to 27%1. The reason for this is the tenuous1 blood supply of the scaphoid, primarily from the branch of the radial artery entering mainly from the distal and dorsal surface of the bone. The proximal pole, therefore, is dependent entirely on this intraosseous blood flow. This retrograde, axial and unidirectional pattern of blood supply can result in a protracted healing process after a fracture which eventually leads to osteonecrosis, collapse and arthritis leading to disability.

 


References


1. Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg 1980; 5:508 –513
2. Herbert TJ, ed. The fractured scaphoid. St. Louis: Quality Medical Publishing, 1990:13–25
3. Fondi C, Franchi A (2007) Definition of bone necrosis by the
pathologist. Clin Cases Miner Bone Metab 4(1):21–26
4. Sakuma M, Nakamura R, Imaeda T. Analysis of proximal fragment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging. J Hand Surg 1995;20B:201–205
5. Smith ML, Bain GI, Chabrel N, Turner P, Carter C, Field J. Using computed tomography to assist with the diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am. 2009 Jul-Aug;34(6):1037-43.
6. Trumble TE, Irving J. Histologic and magnetic resonance imaging correlations in Kienböck’s disease. J Hand Surg Am 1990; 15:879–884
7. Trumble TE. Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg Am. 1990, 15: 557–64.
8. Perlik PC, Guilford WB. Magnetic resonance imaging to assess the vascularity of scaphoid nonunions. J Hand Surg Am 1991; 16:479–484
9. Schmitt R, Christopoulos G, Wagner M et al. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI? Eur J Radiol. 2011, 77:222–7
10. Cerezal L, Abascal F, Canga A, García-Valtuille R, Bustamante M, del Piñal F. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR 2000; 174:141–149
11. Anderson SE, Steinbach LS, Tschering-Vogel D, Martin M, Nagy L. MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting. Skeletal Radiol 2005; 34:314–320
12. Fox MG, Gaskin CM, Chhabra AB, Anderson MW. Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol. 2010, 195: W281–6.
13. Fox MG, Wang DT, Chhabra AB. Accuracy of enhanced and unenhanced MRI in diagnosing scaphoid proximal pole avascular necrosis and predicting surgical outcome. Skeletal Radiol. 2015, 44: 1671–8.
14. Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CWA. Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoid viability in patients with scaphoid nonunion? Radiology. 2011, 260: 808–16.
15. Urban MA, Green DP, Anfdemorte TB. The patchy configuration of scaphoid avascular necrosis. J Hand Surg Am 1993;18A:669–67
16. Gu¨nal I, Ozc¸elik A, Go¨ktu¨rk E, Ada S, Demirtas¸ M. Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion. Arch Orthop Trauma Surg. 1999, 119: 285–7.
17. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am 1985;10A:597–605
18. Boyer MI, von Schroeder HP, Axelrod TS. Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg Br. 1998, 23: 686–90
19. Straw RG, Davis TR, Dias JJ. Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery. J Hand Surg Br.2002;27(5):413
20. Tambe AD, Cutler L, Stilwell J, Murali SR, Trail IA, Stanley JK. Scaphoid non-union: the role of vascularized grafting in recalcitrant non-union of the scaphoid. J Hand Surg Br. 2006, 31: 185–90
21. Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW; Scaphoid Nonunion Consortium. The success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol. 2018 Jan;43(1):32-40.
22. Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am. 2015, 40: 1797–805
23. Kim J, Park JW, Chung J, Jeong Bae K, Gong HS, Baek GH. Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis. J Hand Surg Eur Vol. 2018 Jan;43(1):24-31. doi: 10.1177/1753193417730657. Epub 2017 Sep 11. PMID: 28893145.
24. Schmitt R, Heinze A, Fellner F, Obletter N, Struhn R, Bautz W. Imaging and staging of avascular osteonecrosis at the wrist and hand. Eur J Radiol 1997; 25:92–103
25. Morgan WJ, Breen TF, Coumas JM, Schulz LA. Role of magnetic resonance imaging in assessing factors affecting healing in scaphoid nonunions. Clin Orthop Relat Res 1997; 336:240–246

 


How to Cite this article: Bhat AK, Pai MG, Acharya AM, Shetty SS What | Exactly is Avascular Necrosis in Nonunion Scaphoid? | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 02-07.

 


                                          (Abstract    Full Text HTML)      (Download PDF)