Fractures: scaphoid proximal pole sclerosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures: scaphoid proximal pole sclerosis

Sample item

A 24-year-old had an untreated scaphoid waist fracture. Eight months later radiographs show nonunion with the proximal fragment denser than the surrounding carpal bones. What does this finding suggest?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Avascular necrosis of the proximal fragment

The scaphoid blood supply enters distally and flows retrograde, so a waist fracture can isolate the proximal pole. The deprived fragment cannot take part in disuse osteopenia, so it looks relatively dense. Such nonunion with necrosis often needs vascularised bone grafting.

Option by option

  • A. Normal healing with callus

    Healing would show bridging bone, not a dense isolated fragment.

  • B. Infection of the scaphoid

    Infection would produce lucency and periosteal change.

  • C. Early osteoarthritis only

    Osteoarthritis causes joint space narrowing and does not explain the dense fragment.

  • D. Avascular necrosis of the proximal fragment (correct)

    Correct. Relative density of the proximal fragment indicates loss of blood supply.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Avascular necrosis of the proximal fragment. The scaphoid blood supply enters distally and flows retrograde, so a waist fracture can isolate the proximal pole.

Why is "Normal healing with callus" not the answer?

Healing would show bridging bone, not a dense isolated fragment.

Why is "Infection of the scaphoid" not the answer?

Infection would produce lucency and periosteal change.

Why is "Early osteoarthritis only" not the answer?

Osteoarthritis causes joint space narrowing and does not explain the dense fragment.

What concept does this question test?

It tests Fractures: scaphoid proximal pole sclerosis in Orthopaedics. The deprived fragment cannot take part in disuse osteopenia, so it looks relatively dense. Such nonunion with necrosis often needs vascularised bone grafting.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures: scaphoid proximal pole sclerosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.