Idiopathic osteonecrosis of the scaphoid: a series of 3 surgical cases

Osteonecrosis of the scaphoid is usually a posttraumatic condition, but idiopathic cases are well known to occur. Magnetic resonance imaging is useful in distinguishing the types of osteonecrosis. In posttraumatic osteonecrosis, MRI abnormalities are in the proximal scaphoid that are consistent with interosseous vascular disruption, whereas in idiopathic osteonecrosis, the entire scaphoid is affected. The MRI findings correlate with histologic findings of osteonecrosis, and the etiology may be an extraosseous insult to the scaphoid blood supply. We presented a series of 3 cases of idiopathic global osteonecrosis of the scaphoid. All patients were found to have diffuse swelling of the dorsal wrist and probable effusion, and all had slow clinical deterioration. All 3 patients had surgical procedures that included bone grafting or intracarpal arthrodesis. At 5- to 10-year follow-up, all were satisfied with their treatment.