PMC4977392_01
(a) Plain radiograph at acute presentation showing a fracture of the scaphoid waist with sclerosis, central cystic bone alteration, and deformity of the proximal pole. (b) CT scan 1 week after the initial injury showing a more pronounced central cystic bone alteration and irregularity of the fracture border. (c) MRI T1 showing signal loss of the whole scaphoid.
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AVN (Figure 1(a)). Additional CT scan supported the radiographic findings with a more pronounced central cystic bone alteration and irregularity of the fracture border (Figure 1(b)). T1 (Figure 1(c)). A dynamic contrast-enhanced MRI was performed for further assessment of the proximal pole vascularity and treatment planning.
To assess the vascularity with dynamic contrast-enhanced MRI, a region of interest was placed on the proximal and distal scaphoid poles and time-signal intensity curves were recorded. The dynamic contrast-enhanced MRI showed fair perfusion of the proximal pole with account of measuring associated fibroblasts in the cystic alteration in the distal pole. The time-signal intensity curve on the proximal pole (yellow curve) was lower than the distal pole (red curve) with a maximum enhancement of 50%.
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The fair perfusion of the proximal pole on dynamic contrast-enhanced MRI was with the account of measuring associated fibroblasts in the cystic alteration in the distal pole (Figure 2).
(a) Plain radiograph at the end of cast immobilization showing improved consolidation. (b) CT scan be performed one month after the end of cast immobilization showing union of the fracture.
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Plain radiograph showed improved consolidation and CT scan performed one month later confirmed union of the fracture (Figures 3(a) and 3(b)).