A Rare Case of a Vertical Oblique Scaphoid Fracture Nonunion

Abstract

To the Editor: Three-dimensional computed tomography (CT) modeling enables accurate evaluation of fracture plane orientation in scaphoid fractures. Recently, Luria et al used this technique in 124 scaphoid fractures and concluded that practically all fractures were horizontal oblique, and not transverse. Wewish to report an unusual case of a vertical oblique (VO) scaphoid fracture—a distinct subgroup in Russe’s classification. After punching a boxing ball, a 17-yearold male patient presented to the emergency department with immediate right-sided wrist pain. Radiographs (Fig. 1A) and an additional technetium bone scan indicated a proximal scaphoid fracture, which was immobilized for 12 weeks. Follow-up radiographs showed fracture union. Nine years later, he was referred to our tertiary center, due to, again, right-sidedwrist complaints. A CT scan showed a proximal VO fracture nonunion (Fig. 1B), which was satisfactorily treated with proximal row carpectomy because of painful osteoarthritis. VO fractures are rare (<5% of scaphoid fractures) and typically caused by an axial loading injury. They are notorious for their misinterpretation on plane radiographs. Therefore, we recommend using a CT scan to evaluate the acute fracture morphology and, in direct follow-up, bony consolidation. If an acute VO fracture is recognized, we also recommend using immediate screw fixation because of its unstable nature and higher risk to nonunion. VO fractures may need a distinct surgical plan. To analyze optimal screw placement, we retrospectively used the nonunionCT scan to obtain 3-dimensional CT