Preiser S Disease

Preiser's disease or idiopathic avascular necrosis of the scaphoid is a rare condition that often presents as vague wrist pain with an insidious onset. At this time an etiology has not been elucidated, but there is evidence to suggest that there may be an anatomical or biomechanical basis for the affliction. In all likelihood the etiology is multifactorial. Patients who are predisposed because of anatomic or biomechanical variations need only another, often relatively minor, insult (minor trauma, steroids, collagen vascular disease) to the blood supply of their scaphoid to compromise the bone's viability.

Several classification schemes have been developed in an effort to help predict prognosis and direct treatment [8,22]. The four stages of Preiser's disease, as described by Herbert and Lanzetta [8], begin with normal plain films but positive bone scan and progress to periscaphoid arthritis. At this time it is difficult to ascertain the prognostic value of this classification system. More recently, Kalainov and colleagues [22] developed a classification system that divides Preiser's disease into scaphoids with diffuse or localized necrosis. In their 2003 study they were able to demonstrate that scaphoids with diffuse (type 1) necrosis were more prone to scaphoid fragmentation and poor outcomes. A diagnosis of Preiser's disease requires scaphoid avascular necrosis with no prior history of scaphoid fracture or surgery. Most commonly the diagnosis can be made with the use of plain radiographs, but one should not hesitate to use MRI for both confirming the diagnosis and evaluating the stage of the disease. Currently, there is no consensus on a proper treatment algorithm. The authors prefer to attempt a revascularization

Scaphoid Collapse

Fig. 10. (A, B) Preoperative radiographs demonstrating Preiser's disease with fragmentation of the scaphoid. (C) Preoperative MRI revealing diffuse necrosis, collapse of the proximal scaphoid, and early degenerative changes. (D) Intraoperative photograph demonstrating a scaphoid excision with four-corner fusion using a Spider Limited Wrist Fusion Plate (Kinetikos Medical Incorporated [KMI], Carlsbad, CA). (E, F) Postoperative radiographs illustrating complete scaphoid excision with early limited wrist fusion.

Fig. 10. (A, B) Preoperative radiographs demonstrating Preiser's disease with fragmentation of the scaphoid. (C) Preoperative MRI revealing diffuse necrosis, collapse of the proximal scaphoid, and early degenerative changes. (D) Intraoperative photograph demonstrating a scaphoid excision with four-corner fusion using a Spider Limited Wrist Fusion Plate (Kinetikos Medical Incorporated [KMI], Carlsbad, CA). (E, F) Postoperative radiographs illustrating complete scaphoid excision with early limited wrist fusion.

procedure if the disease is diagnosed early and the scaphoid has not yet gone on to collapse and degenerate, reserving our salvage procedures (four-corner fusion, PRC) for advanced cases with periscaphoid arthritis.

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Responses

  • raffaella
    WHAT IS PRISERS DISEASE?
    6 years ago

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