Avascular necrosis of the carpal bones: A rare condition

Avascular necrosis of the carpal bones other than Kienböck disease Afshar, A., & Tabrizi, A. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Diagnostic/Therapeutic Incidence: Rare Topic: Avascular necrosis of carpal bones- Diagnosis and treatment This is a narrative review of carpal bones avascular necrosis (AVN) diagnosis and treatment. Due to their vascular anatomy, the scaphoid and capitate are the two most common bones presenting with AVN after the lunate. All the other carpal bones can present AVN but it is much less likely. Clinically, patients may present with wrist pain and a history of trauma. Objectively, there may be swelling, range of movement limitations, and grip strength deficits. X-rays are usually negative initially and further MRI imaging is required to make a diagnosis and exclude fractures, infections, and malignancies. Treatment for the initial stage includes NSAIDs, immobilisation, and corticosteroid injections. Bone grafts or surgical interventions with fusion or arthroplasty may be required if conservative treatment fails. Clinical Take Home Message: Avascular necrosis of the lunate (Kienböck's disease) is a rare condition and AVN of other carpal bones is even rarer. However, it is not unheard of and all the carpal bones can develop AVN with the scaphoid and capitate being the most prevalent after the lunate. Due to the possibility of scaphoid fractures resulting in AVN of the proximal pole or scaphoid non-uniuon advance collapse (SNAC), patients should be monitored closely during their recovery. Chronic pain following fractures of the hook of the hamate may alert the hand therapists to AVN of the hook which needs to be assessed through MRI. URL: https://www.jhandsurg.org/article/S0363-5023(18)31168-7/fulltext


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