Current diagnostic methods for detecting avascular necrosis and irreversible bone death of the proximal pole of the scaphoid: a systematic review.
Sophia Jacobi, Emily Davidovic-Katz, Samara Moll et al.
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In 30 seconds
This systematic review examined how reliably MRI, CT, intraoperative findings and histology distinguish avascular necrosis (AVN) from irreversible bone death in the proximal scaphoid. It included 27 studies and 423 patients, but found that studies diagnosed patients with AVN alone, without a standardized diagnosis of irreversible bone death. Among patients labelled as having AVN, 195 out of 223 diagnosed by MRI healed; healing occurred in nine out of 21 diagnosed by CT, 308 out of 356 with no intraoperative punctate bleeding, and six out of 19 assessed histologically.
Key findings
- Of 223 patients diagnosed with AVN by MRI, 195 healed.
- Nine out of 21 patients diagnosed with AVN by CT healed.
- Among patients with no intraoperative punctate bleeding, 308 out of 356 healed; after histologic evaluation, six out of 19 healed.
- The review found no standardized method for diagnosing irreversible bone death, as the literature conflated it with AVN.
Why it matters
AVN and irreversible bone death have distinct pathologies and prognoses, yet the reviewed studies did not reliably separate them. Healing among patients labelled as having AVN varied across diagnostic approaches, underscoring that a diagnosis of AVN alone may not establish irreversible loss of bone viability. Clearer diagnostic definitions are needed to interpret outcomes and compare evidence.
What to keep in mind
The review found that included studies diagnosed AVN alone and lacked a standardized method for identifying irreversible bone death, limiting conclusions about how well the methods distinguish the two conditions.