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Posttraumatic Cystlike Defects of the Scaphoid: Late Sign of Occult Microfracture and Useful Indicator of Delayed Union

¹ Both authors: Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Hospital Close, Leicester LE1 5WW, United Kingdom.

View larger version (141K): [in a new window]   Fig. 1A. — 18-year-old man who is right-handed presented with history of fall onto his right outstretched wrist while riding mountain bike. Initial radiograph of scaphoid obtained 3 weeks after injury shows no obvious fracture.

View larger version (98K): [in a new window]   Fig. 1B. — 18-year-old man who is right-handed presented with history of fall onto his right outstretched wrist while riding mountain bike. Unenhanced radiograph obtained 6 weeks after plaster immobilization of wrist was initially interpreted as showing no abnormality. On review, radiograph shows subtle fracture line (arrowhead) along capitate surface of scaphoid.

View larger version (100K): [in a new window]   Fig. 1C. — 18-year-old man who is right-handed presented with history of fall onto his right outstretched wrist while riding mountain bike. Radiograph of scaphoid obtained 7 months after trauma shows radiolucency and fracture running through it. Note increased sclerosis of proximal pole.

View larger version (131K): [in a new window]   Fig. 1D. — 18-year-old man who is right-handed presented with history of fall onto his right outstretched wrist while riding mountain bike. CT scan obtained 1 month after C shows focal radiolucency (-51 H) in scaphoid, indicating fatty tissue in scaphoid complicated by fracture.

View larger version (151K): [in a new window]   Fig. 2A. — 39-year-old man who is right-handed presented with history of injury to his right wrist while fighting. Radiograph of scaphoid obtained 2 days after injury shows no fracture.

View larger version (114K): [in a new window]   Fig. 2B. — 39-year-old man who is right-handed presented with history of injury to his right wrist while fighting. Radiograph obtained 13 days after A shows radiolucent area in waist of scaphoid with fracture.

View larger version (123K): [in a new window]   Fig. 2C. — 39-year-old man who is right-handed presented with history of injury to his right wrist while fighting. CT scan obtained 1 week after B shows focal radiolucent defect with oblique fracture through waist of scaphoid.

View larger version (128K): [in a new window]   Fig. 3A. — 20-year-old man with dorsiflexion injury to his wrist incurred while playing soccer. Radiograph obtained 1 week after injury shows fracture through waist of scaphoid.

View larger version (142K): [in a new window]   Fig. 3B. — 20-year-old man with dorsiflexion injury to his wrist incurred while playing soccer. Radiograph obtained 7 weeks after A shows radiolucency in waist of scaphoid with marked osteopenia of carpus and increased sclerosis of fracture lines.

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