After a galley door slammed shut on his right wrist, a 37-year-old deckhand sought medical attention. He had no history of previous injury to the wrist. On examination, he had 50% of normal range of motion, and there was palpable tenderness and bony swelling at the dorsum of the wrist.
An x-ray film (A) was surprising: it showed absence of the
scaphoid bone, secondary degenerative changes primarily in the capitate and lunate bones, extreme atrophy of the radial styloid, and a deformed radial articular surface with an almost transverse orientation of the radiocarpal joint. Normal bone structure is shown for comparison (B).
Absence of the carpal scaphoid bone is rare. In most of these patients, there are congenital malformations in other body systems as well, and a "VATER" syndrome is found in
some.1 This consists of three or more of the following malformations: vertebral defects; anal atresia; tracheoesophageal fistula; and renal and radial dysplasia.
REFERENCE: 1. Treble NJ. Congenital absence of the scaphoid in the ‘VATER’ association. J Hand Surg [Br]. 1985;10: 251-252.
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