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

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 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,