Preiser Disease

Definition

Idiopathic avascular necrosis of the scaphoid without a preceding fracture.

Aetiology

• Corticosteroids, systemic lupus erythematosus, chemotherapy, alcohol and smoking
• Repetitive microtrauma
• Retrograde scaphoid blood supply leaves the proximal pole vulnerable

Epidemiology

• Rare, and less common than Kienbock’s disease
• Adults, with no fracture history by definition

Classification

• Kalainov MRI Type 1. Diffuse necrosis of the whole scaphoid
• Kalainov MRI Type 2. Segmental necrosis, usually of the proximal pole
• Herbert and Lanzetta Stage I. Normal radiographs with abnormal MRI
• Stage II. Increased scaphoid density
• Stage III. Proximal pole fragmentation
• Stage IV. Carpal collapse and radiocarpal arthritis

Clinical Features

• Dorsoradial wrist pain without a fracture history
• Snuffbox tenderness and reduced wrist motion

Investigations

• Radiographs normal early, then sclerosis and fragmentation
• MRI shows low T1 signal and defines the Kalainov type
• CT for fragmentation and collapse

Differential Diagnosis

• Scaphoid nonunion
• Scaphoid fracture
• Kienbock’s disease
• Intraosseous ganglion
• Inflammatory arthritis

Management

• Immobilisation. Early stages, with frequent progression despite treatment
• Vascularised bone graft. Stage II without degenerative change
• Proximal row carpectomy. Stage III with fragmentation
• Scaphoid excision and four-corner fusion. Collapse with midcarpal arthritis
• Total wrist fusion. Pancarpal arthritis

Prognosis

• Type 1 tends to fragment and collapse whatever the treatment
• Type 2 often follows trauma and has better wrist scores
• Surgery gives more pain relief than non-operative care in Stages II and III

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.