Document Detail

Idiopathic avascular necrosis of the scaphoid: 10 new cases and a review of the literature. Indications for Preiser's disease.
MedLine Citation:
PMID:  22608001     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Avascular necrosis of the scaphoid (Preiser's disease) is a rare entity for which there are no treatment guidelines to date. The aim of this study was to delineate the optimal treatment at different stages of this disease, based on an analysis of the cases treated in our department.
MATERIALS AND METHODS: Ten wrists (nine patients) were retrospectively reviewed after a mean 92 months of follow-up. The initial diagnosis was stage II avascular necrosis in four cases, stage III in four cases and stage IV in two cases. These patients were treated by conservative treatment (non surgical) in three cases, vascularized bone graft in two and palliative treatments (proximal row carpectomy or partial fusion) in five. Radiological examination, sometimes completed by MRI, and functional assessment of range of motion, grip strength and Mayo Wrist Score were performed.
RESULTS: Completely different results were obtained in the two stage II cases treated by conservative treatment, while functional results improved in the two cases treated by vascularized bone graft with regression of necrosis on MRI. Pain improved following palliative treatment in 4/5 stage III and IV wrists. Functional results were satisfactory with conservative treatment in one stage IV case for 13 years but worsened at the final follow-up assessment.
DISCUSSION: A review of the literature, including 126 cases in 29 articles clarified the role of conservative treatment, vascularized bone grafts and proximal row carpectomy in the treatment of avascular necrosis of the scaphoid. Conservative treatment is ineffective in the early stages and nearly always results in disease progression. In contrast vascularized bone grafts can stop or even reverse damage at stage II. Palliative treatment is indicated when facing irreversible lesions.
LEVEL OF EVIDENCE: Level IV - Retrospective study.
H Lenoir; B Coulet; C Lazerges; O Mares; P Croutzet; M Chammas
Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2012-05-16
Journal Detail:
Title:  Orthopaedics & traumatology, surgery & research : OTSR     Volume:  98     ISSN:  1877-0568     ISO Abbreviation:  Orthop Traumatol Surg Res     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-05     Completed Date:  2012-10-24     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  101494830     Medline TA:  Orthop Traumatol Surg Res     Country:  France    
Other Details:
Languages:  eng     Pagination:  390-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Department of Hand and Upper Extremity Surgery, Lapeyronie Teaching Hospital Center, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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MeSH Terms
Hand Strength
Magnetic Resonance Imaging
Middle Aged
Osteonecrosis / pathology*,  therapy*
Range of Motion, Articular
Retrospective Studies
Scaphoid Bone / pathology*
Treatment Outcome

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