Virginia Via Research Day Book 2026

Medical Student Research Case Reports

39 SCAPHOID AVASCULAR NECROSIS WITH RIGHT MEDIAL FEMORAL CONDYLE VASCULARIZED BONE GRAFT: A CASE REPORT

Hope Gough, OMS-II; Dr. Mary Mitchell, DO, CAQSM Corresponding author: hgough@vcom.edu

VCOM-Virginia, Blacksburg, Virginia Context: The scaphoid bone is commonly fractured in athletes and warrants prompt evaluation to prevent complications. Injuries to this bone, particularly the proximal pole, have a significant risk of developing non union and avascular necrosis due to retrograde blood flow and limited vascularity. The primary objective of this paper is to report a case of scaphoid avascular necrosis in an athlete with successful treatment using medial femoral condyle vascularized bone graft. While scaphoid bone injuries with proximal pole avascular necrosis are well described in literature, there is limited discussion about collegiate soccer goalkeepers, an athletic population exposed to repetitive wrist hyperextension mechanisms rather than the classic fall on outstretched hand (FOOSH) mechanism. Case Report: An 18 year old, right hand dominant, male soccer goalkeeper was referred for right wrist pain that has persisted since having an ORIF of the right scaphoid proximal pole nonunion with distal radius bone graft 09/05/2023. He denied any clear inciting event, but stated he initially thought he had a sprain. He reported issues with mobility and occasional severe right hand

pain, specifically when it was impacted forcefully or he absorbed a full shot. He has otherwise continued to play soccer with limited ability to bend his hand. On his physical examination, his right wrist revealed a well healed dorsal incision. Wrist flexion was noted to 90 degrees. Wrist extension was limited to 20 degrees. Mild tenderness to palpation. No reported pain with radial or ulnar deviation. No crepitus noted. X-ray performed revealed a scaphoid fracture with 2 interfragmentary screws in place. There was sclerosis within the proximal pole fragment from avascular necrosis. CT scan was ordered for further evaluation and revealed a proximal scaphoid fracture with 2 interfragmentary screws. The fracture showed less than 10% osseous bridging with a narrow zone of lucency surrounding the longer fixation screw. There was relative sclerosis of the proximal scaphoid fragment suspicious for avascular necrosis. The CT results and concerns for proximal pole of scaphoid involvement were discussed with the patient. He was recommended treatment with femoral condyle

free tissue transfer. On 11/12/25, the patient underwent right medial femoral condyle vascularized bone flap from the right knee to the right wrist with microvascular anastomosis. Repair of scaphoid nonunion was performed with internal fixation, hardware removal, radial styloidectomy and capsulodesis. During follow up on 11/20/25, the patient reported doing well following the procedure. The patient’s sutures were removed and he was placed in a short arm cast, with plans to work on making a composite fist. Comments: High velocity shots can hyperextend a goalkeeper’s wrist, placing focused load on the scaphoid and increasing risk of injury. Medial femoral condyle vascularized bone graft has been shown to be an excellent treatment for scaphoid non-union with avascular necrosis of the proximal pole, as experienced in this patient. This treatment provides well-vascularized and dense bone to restore motion in the wrist. Diagnosis: Scaphoid nonunion of the proximal pole with collapse of scaphoid.

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