Elsevier

Hand Clinics

Volume 22, Issue 4, November 2006, Pages 475-484
Hand Clinics

Idiopathic Avascular Necrosis of the Scaphoid: Preiser's Disease

https://doi.org/10.1016/j.hcl.2006.07.005Get rights and content

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Vascular anatomy/biomechanics

Serving as a mechanical link between the proximal and distal carpal rows, the scaphoid is vital for maintaining normal wrist kinematics (the details of which are beyond the scope of this article). To maintain carpal relationships, the scaphoid has five articulations (trapezium, trapezoid, capitate, lunate, and distal radius). Thus, despite its small size, this carpal bone is nearly entirely covered in cartilage (Fig. 2). This correlates with the previously mentioned findings of Gelberman and

Classification

Three classification systems have been devised for grading scaphoids afflicted with Preiser's disease [8], [22]. The first scheme, derived by Herbert and Lanzetta in 1993 [8], is based on the progression of the disease as seen with plain radiographs. Based on four stages, this system starts at stage 1 with normal radiographs but a positive bone scan, and ends at stage 4 with total collapse of the scaphoid and periscaphoid arthritis (Table 1). Looking at the patient outcomes makes it difficult

Diagnosis

By definition, patients who have Preiser's disease will not have a significant history of wrist trauma or prior scaphoid fracture or surgery; however, patients will frequently relay a history of prior wrist hyperextension or heavy labor. Clinically, the vast majority of patients will present with pain that is insidious and worsening in nature. The pain is often present for months to years before presentation, and it typically localizes to the dorso-radial aspect of the wrist.

On examination,

Treatment

The treatment of idiopathic AVN of the scaphoid remains a confusing and often frustrating dilemma for the treating surgeon. Currently, there is no standardized treatment algorithm for patients affected by Preiser's disease. Because of the lack of treatment protocols many patients are treated conservatively until degeneration of the carpus or pain require that a salvage procedure be performed.

Adding to the confusion from the paucity of treatment guidelines is the number of different methods

Summary

Preiser's disease or idiopathic avascular necrosis of the scaphoid is a rare condition that often presents as vague wrist pain with an insidious onset. At this time an etiology has not been elucidated, but there is evidence to suggest that there may be an anatomical or biomechanical basis for the affliction. In all likelihood the etiology is multifactorial. Patients who are predisposed because of anatomic or biomechanical variations need only another, often relatively minor, insult (minor

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      Articles containing quantitative or qualitative data of interested variable outcomes were considered. We also read all review articles to ensure that we had not missed any references cited in these articles in our initial search; however, these review papers were not included in the study results [2–21]. Almost all included articles were case reports and case series.

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      The most cited risk factors were smoking and a distant history of antecedent trauma. A history of trauma was reported for many of the patients, as has been noted in other reports, and it is possible that many cases of scaphoid AVN stem from prior injury.6,26,27 Kalainov et al6 found that Preiser patients with type 2/segmental AVN had a trauma history more frequently than those with type 1/disseminated AVN.

    • Preiser's disease

      2022, Hand Surgery and Rehabilitation
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      We recognize that the surgical treatments available in that era were not satisfactory, which explains their conclusions. Lauder and Trumble [22] did a review of literature that identified 31 patients of which 29 were treated non-surgically; unfortunately, 80% had poor clinical and radiological outcomes. Kalainov et al. [17] described a series of 19 cases: 11 cases of type I scaphoid, which after non-surgical treatment, had significant progression of the radiological disease stage between 3 and 68 months of follow-up; 8 cases of type II scaphoid that were initially treated non-surgically, with two fair results and five early failures that led to secondary surgical treatment with vascularized graft.

    • Preiser's disease or avascular osteonecrosis of the scaphoid: An updated literature review

      2021, Hand Surgery and Rehabilitation
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      Vidal et al. [24] considered their results average to good at an mean follow-up of 6.9 years, with resolution of pain (absent or minimal). Lauder and Trumble [47] found less favorable results, and 94% of patients presented clinical or radiographical worsening. In two Herbert stage 2 cases, Lenoir et al. [34] found diverging results.

    • Management of ‘radiocarpal arthritis’

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