Preiser's disease

Preiser's disease or aseptic necrosis of the scaphoid is a rare condition whose treatment, whether surgical or non-surgical, is not yet well defined. Its etiology remains unknown, and the treatment options depend on the disease's progression. Two classifications summarize the progress of this condition; the first by Hebert has four stages based on radiographic findings and the other by Kalainov defines two types according to extent of necrosis on MRI. A review of literature and our experience has led us to propose a decision-making algorithm for its therapeutic management, from conservative treatment to surgical treatment. The surgical procedure is chosen based on the disease stage and the extent of necrosis. According to Zaidemberg, in the early stages of the disease, treatment with a vascularized graft is the preferred solution. For more advanced stages, several techniques are available ranging from scaphoidectomy with potential prosthetic replacement or proximal row carpectomy to more radical solutions such as carpal arthrodesis. However, given the rarity of this disease, the indications for surgery remain tricky.