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The patchy configuration of scaphoid avascular necrosis
M A Urban1, D P Green, T B Aufdemorte
1Hand Center of San Antonio, TX 78229.
The Journal of Hand Surgery
|July 1, 1993
Summary
Histological analysis of avascular necrosis in the scaphoid bone revealed variable and patchy distribution of dead bone. Random biopsies are insufficient for assessing scaphoid viability, necessitating alternative diagnostic methods.
Area of Science:
- Orthopedic surgery
- Bone pathology
- Histology
Background:
- Avascular necrosis of the scaphoid bone is a common complication, often resulting from nonunion.
- Accurate assessment of bone viability is crucial for effective treatment planning.
Purpose of the Study:
- To histologically evaluate the extent and distribution of avascular necrosis in the proximal scaphoid poles.
- To determine the reliability of random biopsies in assessing scaphoid viability.
Main Methods:
- Histological analysis of five proximal scaphoid pole specimens.
- Qualitative review by a bone pathologist.
- Quantitative assessment using a computerized image analysis system.
Main Results:
- Avascular necrosis varied significantly within and between specimens.
- The midcentral scaphoid region showed a statistically significant higher degree of avascular necrosis.
- Viable and nonviable bone areas were found in an unpredictable, patchy distribution.
Conclusions:
- Histological assessment demonstrates a patchy and variable distribution of avascular necrosis in the scaphoid.
- Random biopsies are inadequate for determining the overall histologic status of the scaphoid.
- Clinicians should utilize methods beyond random biopsy to ascertain scaphoid viability.