Diagnosing Vascularity Issues of the Scaphoid

The vascularity of the scaphoid is of special interest in two issues, scaphoid nonunion, and Preiser disease. Vascularity and viability of the proximal fragment in a scaphoid nonunion can be assessed by imaging, surgical inspection with visualization of bleeding points, and bone biopsy examination. From the different imaging approaches to assess scaphoid vascularity—conventional radiographs, computed tomography, bone scintigraphy, unenhanced MRI, and gadolinium-enhanced MRI—gadolinium-enhanced MRI has the best results regarding sensitivity, specificity, and positive and negative predictive values of proximal pole viability with an overall moderate quality. There are two types of Preiser disease. In type 1 ischemia involves the entire scaphoid, while in type 2 only a part of the scaphoid is involved. Most patients with a type 2 Preiser report on a wrist trauma, while only a few with type 1 Preiser report a precipitating wrist injury. Treatment do not influence the history of type 1 Preiser resulting in a fragmented and collapsed scaphoid, while the prognosis with a minimally altered architecture after treatment is much better in type 2 Preiser.