ROUNDS RESPONSE.
Rounds is your vehicle for sharing your orthopaedic skills and experience. Your response to Rounds will be published in a future issue of Body Cast. We invite you to suggest questions for this column. Please address all submissions to:
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In the last issue of Body Cast, Rounds asked: What is Preiser's Disease?
The following answers were received:

From Brad DeWagner-contributor:

This disease process can be defined as an aseptic necrosis of one of the carpal bones, specifically the scaphoid. This is a very rare condition first described by Preiser in 1910 and is very similar to Keinbock's disease, which affects the lunate, in that through the suppression of the blood supply to the bone, bone tissue dies, thus the term necrosis. There appears to be no correlation between trauma and the disease process, as the clinical signs generally appear quite vague presenting as wrist pain on the thumb side with no known incident or condition that precedes the clinical findings. An extremely rare condition, the pathology remains quite mysterious while generally affecting young adults. Further examinations should include standard x-ray
(scaphoid views) in association with an MRI to determine the stage of disease process prior to surgical treatment. The fact that there has been no prior trauma to the area can help to eliminate a diagnosis of non-union fracture. Early diagnosis while the scaphoid retains its shape and cartilage remains intact can lead to a prognosis that is quite good following surgical intervention.

From Alex Tarambikos:
A rare avascular disease of the scaphoid without prior fractures. Most likely cause would be repetitive microfractures, side effects of drugs such as steroids or chemotherapy. as well as a decrease in proximal scaphoid vascularity. There are three stages of AVN-stage three usually requires surgery with total to partial arthrodesis, i.e. removing the scaphoid and fixing the wrist bones with a spider plate or wires for stabilization.

From Brenda Manley:
When the blood supply to a bone is compromised, the bone tissue will eventually die. Otherwise known as avascular necrosis. Preiser's disease is avascular necrosis of the scaphoid bone without a fracture or trauma. It may be caused by the side effects of steroids or chemotherapy.

From Staush Jankowski:
Preiser's disease is named after Dr. Preiser who, in 1910, identified the osteonecrosis of the proximal pole of the scaphoid without any apparent trauma or fracture to the carpal bone. It is a rare condition and controversially thought to be caused spontaneously or by a series of microfractures, or even the effects of chemotherapy or steroidal mugs. The only method of treatment is surgery, either a total or partial wrist arthrodesis resulting in permanently reduced wrist motion.

Answers to the last rounds question were also received from:
L. Arseneau, T. Broughton, M.J. Buchner, L. Burk, A. Carlos, L. Chen, R. Chun, E. Clancey, B. Doucet, D. Edwards, N.
Ellsworth, W. Fast, M. Florian, I. Fluerar, C. Gaudon, M. Gillingham, R. Grenier, S. Groulx, S. Hutchinson, S.
Jankowski, L. Johnson, B. Lavallee, N. Lockyer, C. Longphee, B. Manley, G. Marshall, B. Matheson, J. Meyer, M.
Monteleone, J. Movasseli, E. Oborowsky, K. Petereit, J.P. Piche, J. Pike, L. Pirzale, 1. Punwassie, D. Purvey, B.
Rawlings, P. Ritchie, V. Robichaud, E. Seguin, B. Sheppard, A. Tarambikos, S. Tilley, T. Tsangaris, M. Unger, A. Wentzell, R. Wong, J. Yarnell, and T. Yorke.