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Scaphoid fractures are one of the common carpal injuries and, despite their prevalence, the imaging diagnosis in the early stages remains problematic. Plain radiographs with dedicated views of the scaphoid bone are standard in most institutions. Displaced scaphoid fractures are easily diagnosed but minimally or undisplaced fractures may be occult in the early stages. Negative plain films are often treated as fracture with casting for a number of weeks. Early clinical review may support the diagnosis, occasionally MRI is performed at this time to confirm. More usually treatment is continued until the fracture heals usually for approximately 6 to 8 weeks. If there are still symptoms at this stage, MRI plays an important role in deciding whether the cast can be removed or further treatment required. Coronal orientated T1 and fat suppressed images are very helpful. If the scaphoid is not fractured, the radial styloid, other carpal bones and base of the thumb should be scrutinised carefully
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The principal complication of scaphoid fracture is avascular necrosis. This arises because of the unique blood supply of the bone. Fracture through the scaphoid waist may disrupt this blood supply and lead to avascular necrosis of the proximal pole. Plain films may demonstrate preservation of normal bone density in the light of reducing bone density elsewhere. Signs on MRI include loss of normal narrow signal on T1 weighted images in the proximal pole. on its own, this may simply reflect fracture oedema. The T2 weighted images must therefore also be considered. If marrow signal is also low on these images, avascular necrosis is likely. dynamic enhancement has also been used occasionally and may assist with the diagnosis in some cases.
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Scaphoid necrosis advanced collapse
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Scaphoid
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