Preiser disease, or avascular necrosis

Avascular necrosis

Avascular necrosis is a disease where there is cellular death of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses...

 of the scaphoid, is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture. It is thought to be caused by repetitive microtrauma or side effects of drugs (e.g., steroids or chemotherapy) in conjunction with existing defective vascular supply to the proximal pole of the scaphoid. MRI coupled with CT and X-ray are the methods of choice for diagnosis.

Treatment

Scaphoid AVN (avascular necrosis) needs surgical intervention. Depending on the age of the fracture, the Scaphoid AVN is classified in stages from 1 to 3, being 3 the most advanced. Usually physicians will perform a total or partial wrist arthrodesis, which is a procedure consisting in the removal of the bone and fixation of the remaining wrist bones with a plate (called a "spider plate") or wires in order to provide stability. The plate usually is left inside the patient's wrist, while the wires (usually K-wires) have to be removed in a second surgery. The procedure of partial wrist fusion allows for limited wrist movement, whereas total wrist fusion immobilizes the wrist permanently. Unfortunatelly currently this is the most advanced procedure available, and the patient will never have a full functioning wrist again. Another problem that patients commonly suffer after surgical intervention is wrist arthritis.

History

First described by Preiser in 1910 in 5 patients, all with previous history of wrist trauma, and scaphoid fractures in 3 of them.