case_images: PMC4977392_01
case_images: (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.
case_images: CRIOR2016-7898090.001.jpg
case_images: PMC4977392_01_CRIOR2016-7898090.001.jpg
case_images: fig1
case_images: 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.
case_images: 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%.
case_images: CRIOR2016-7898090.002.jpg
case_images: PMC4977392_01_CRIOR2016-7898090.002.jpg
case_images: fig2
case_images: 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).
case_images: (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.
case_images: CRIOR2016-7898090.003.jpg
case_images: PMC4977392_01_CRIOR2016-7898090.003.jpg
case_images: fig3
case_images: Plain radiograph showed improved consolidation and CT scan performed one month later confirmed union of the fracture (Figures 3(a) and 3(b)).