Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion

Thirty-two patients with radiographic evidence of scaphoid nonunion were pr eoperatively evaluated by magnetic resonance imaging (MRI), then observed i ntraoperatively for punctate bleeding of the fragments. Although MRI and in traoperative findings matched in 19 patients, there was no correlation in 1 3 patients. While 7 of these latter patients showed normal MRI but no punct ate bleeding during the operation, the remaining 6 had preoperative MRI of avascularity but punctate bleeding during the operation. After internal fix ation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.