Idiopathic Preiser disease managed with cyst excision, distal radius bone grafting, and headless compression screw fixation: a case report

Abstract

Preiser disease is an uncommon disorder characterized by idiopathic osteonecrosis of the scaphoid without preceding fracture. Owing to its rarity and nonspecific symptoms, diagnosis is frequently delayed, and the optimal management remains challenging. A 47-year-old right-hand-dominant male presented with a three-year history of progressively worsening left wrist pain, reduced grip strength, and functional limitation without previous trauma. Clinical examination demonstrated localized scaphoid tenderness with restricted wrist motion. Plain radiographs showed cystic changes without fracture, while magnetic resonance imaging (MRI) demonstrated diffuse marrow signal alteration consistent with idiopathic scaphoid osteonecrosis without carpal collapse or degenerative arthritis. The patient underwent excision of the scaphoid cyst, autologous cancellous bone grafting from the distal radius, and fixation with a 2.4-mm headless compression screw. The postoperative period was uneventful. At one-month follow-up, radiographs demonstrated satisfactory screw position, maintained scaphoid alignment, stable graft incorporation, and no evidence of hardware failure or carpal collapse. Clinical recovery progressed as expected with immobilization followed by supervised rehabilitation. This report highlights the importance of considering Preiser disease in patients with persistent wrist pain despite the absence of trauma. MRI plays a crucial role in early diagnosis, and joint-preserving reconstruction using cyst excision, distal radius cancellous bone grafting, and headless compression screw fixation may provide encouraging early clinical and radiographic outcomes in appropriately selected patients.