The Results of Scaphoid Avascular Necrosis Can Be More Than Just Wrist Pain in Patients with Spinal Cord Injury

Timur Ekiz
2015 Pain Physician  
A 30-year-old man with a complete L2 level of spinal cord injury (SCI) was seen due to right wrist pain. Medical history revealed a scaphoid fracture due to fall 6 months ago. Although surgical fixation was recommended in that period, the patient had refused surgery and static hand-wrist splint was recommended. The patient also stated that the pain worsened progressively over months. He could not use a walker and therefore could not ambulate due to hand pain. He also had challenges in self-care
more » ... activities such as catheter use, and he became more dependent in his activities of daily living (ADL). On physical examination, palpation of the right carpal bones was painful. Laboratory investigations were not remarkable. X-rays of the wrists and hands demonstrated a scaphoid fracture on the right side (Fig. 1) . Magnetic resonance imaging (MRI) showed bone marrow edema and fracture of the scaphoid bone (Fig. 2) . Overall, the patient was diagnosed with avascular necrosis (AVN) of the scaphoid and referred to the hand surgery department. Scaphoid fractures are the most common type of carpal fractures and they are usually seen after a forced dorsiflexion wrist injury (1). On the other hand, AVN is the collapse and necrosis of the bone due to the loss of blood supply. Femoral head, Fig. 1. Plain radiographs show right scaphoid fracture (arrowhead). humeral head, knee joints, and neck of the talus are the most common places for AVN (1). In addition, AVN is a common complication due to the delay in the diagnosis/treatment of scaphoid fractures (2). Although AVN after scaphoid fractures has been reported as a common complication, to the best of our knowledge, AVN in a patient with SCI and its association with ADL has not been reported yet. Fractures, trauma, corticosteroid use, alcoholism, thrombosis, and vascular problems are the risk factors for AVN (3). In our case, scaphoid fracture has already played a role in the development of AVN. Moreover, to use a walker over long-term periods might cause repetitive trauma and aggravate the development of AVN. AVN of the scaphoid classically presents with pain and some limitations in hand activities in populations without SCI. However, upper extremities are quite vital for ADL, mobilization, and transfers in SCI patients. Likewise, our pa-
doi:10.36076/ppj/2015.18.e251 fatcat:kjmur6fczfd4tfapdlvld7l654