Avascular Necrosis of the Scaphoid Preiser Disease



1 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2 The University of Texas at Austin, Austin, TX, USA


No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,
classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previous
trauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids as
Herbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered and
only two patients received surgical treatment. We found that chosen treatment is not associated with the severity of
Herbert Lanzetta stage and the outcome is not influenced by chosen treatment.
Level of evidence: I


Main Subjects

1. Preiser G. Eine typische posttraumatische und zur
spontanfraktur fuhrende ostitis des naviculare
carpi. Fortschr Geb Roentgenstr. 1910; 15:189-97.
2. Kallen AM, Strackee SD. On the history and definition
of Preiser’s disease. J Hand Surg Eur Vol. 2014;
3. Green N, Osmer JC. Small bone changes secondary
to systemic lupus erythematosus. Radiology. 1968;
4. Herbert TJ, Lanzetta M. Idiopathic avascular necrosis
of the scaphoid. J Hand Surg Br. 1994; 19(2):174-82.
5. Gelberman RH, Menon J. The vascularity of the
scaphoid bone. J Hand Surg Am. 1980; 5(5):508-13.
6. Schmitt R, Frohner S, van Schoonhoven J, Lanz U,
Golles A. Idiopathic osteonecrosis of the scaphoid
(Preiser’s disease)--MRI gives new insights
into etiology and pathology. Eur J Radiol. 2011;
7. Vidal MA, Linscheid RL, Amadio PC, Dobyns JH.
Preiser’s disease. Ann Chir Main Memb Super. 1991;
8. De Smet L, Aerts P, Walraevens M, Fabry G. Avascular
necrosis of the carpal scaphoid: Preiser’s disease:
report of 6 cases and review of the literature. Acta
Orthop Belg. 1993; 59(2):139-42.
9. Kalainov DM, Cohen MS, Hendrix RW, Sweet S, Culp
RW, Osterman AL. Preiser’s disease: identification of
two patterns. J Hand Surg Am. 2003; 28(5):767-78.
10. Lenoir H, Coulet B, Lazerges C, Mares O, Croutzet
P, Chammas M. Idiopathic avascular necrosis of
the scaphoid: 10 new cases and a review of the
literature. Indications for Preiser’s disease. Orthop
Traumatol Surg Res. 2012; 98(4):390-7.
11. Lin JD, Strauch RJ. Preiser disease. J Hand Surg Am.
2013; 38(9):1833-4.
12. Aptekar RG, Klippel JH, Becker KE, Carson DA,
Seaman WE, Decker JL. Avascular necrosis of the
talus, scaphoid, and metatarsal head in systemic
lupus erythematosus. Clin Orthop Relat Res. 1974;
13. Milgram JW, Riley LH Jr. Steroid induced avascular
necrosis of bones in eighteen sites: a case report.
Bull Hosp Joint Dis. 1976; 37(1):11-23.
14. Kawai H, Tsuyuguchi Y, Yonenobu K, Inoue A, Tada K.
Avascular necrosis of the carpal scaphoid associated
with progressive systemic sclerosis. Hand. 1983;
15. Klipper AR, Stevens MB, Zizic TM, Hungerford
DS. Ischemic necrosis of bone in systemic lupus
erythematosus. Medicine (Baltimore). 1976; 55(3):
16. Urman JD, Abeles M, Houghton AN, Rothfield NF.
Aseptic necrosis presenting as wrist pain in SLE.
Arthritis Rheum. 1977; 20(3):825-8.
17. Moran SL, Cooney WP, Shin AY. The use of
vascularized grafts from the distal radius for the
treatment of Preiser’s disease. J Hand Surg Am.
2006; 31(5):705-10.
18. Chang CC, Greenspan A, Gershwin ME. Osteonecrosis:
current perspectives on pathogenesis and treatment.
Semin Arthritis Rheum. 1993; 23(1):47-69.
19. Virik K, Karapetis C, Droufakou S, Harper P. Avascular
necrosis of bone: the hidden risk of glucocorticoids
used as antiemetics in cancer chemotherapy. Int J
Clin Pract. 2001; 55(5):344-5.
20. Lauder AJ, Trumble TE. Idiopathic avascular necrosis
of the scaphoid: Preiser’s disease. Hand Clin. 2006;
Volume 8, Issue 1
January 2020
Pages 94-98
  • Receive Date: 06 June 2019
  • Revise Date: 13 September 2019
  • Accept Date: 30 September 2019
  • First Publish Date: 01 January 2020