A case send by Dr Sujay for opinion

37 year old rt. handed male (profession unknown) with 8 yr old injury. Is it a SNAC wrist? Early radial styloid scaphoid OA. No DISI. Scaphoid does not seem to be flexed. Not great xrays

Plan

SCope , styloidectomy and if midcarpal and rest of scaphoid is normal. Attempt the nonunion with a vascularised bone graft as the proximal pole appears to be ? avscular. Pt cannot afford an mri.

If finacially challenged, may be a scaphoidectomy and a 4 corner fusion should give him 10 year pain relief if it works. Any other views

jacob