Wrist Pain - Soccer

HISTORY: A 17-year-old high school soccer player presented for repeat evaluation of a soft tissue mallet injury. During the examination, he reported bilateral wrist pain that had begun after catching a soccer ball three weeks prior. He denied any prior history of wrist trauma. PHYSICAL EXAMINATION: The patient displayed tenderness in the anatomic snuffbox and over the scaphoid tubercle on both wrists, with no tenderness to palpation over the distal radius. He had good wrist range of motion, though it was accompanied with pain. Neurovascular assessment demonstrated intact AIN, PIN, and ulnar nerves, with normal sensation and 2+ radial pulse. DIFFERENTIAL DIAGNOSIS: 1. Bilateral scaphoid stress fracture2. Bilateral distal radius fracture3. Bilateral wrest tendinopathy TEST AND RESULTS: Anterior-posterior and lateral radiographs:— Closed, comminuted fractures of left and right scaphoid waists, with nonunion in both wrists, early cystic changes in the left scaphoid, and significant cystic changes in the right scaphoid CT scans:— Bilateral scaphoid nonunions with bilateral cystic changes and bony loss, though no humpback deformity— Fracture displacement of less than 1 mm FINAL WORKING DIAGNOSIS: Bilateral incidental scaphoid fracture TREATMENT AND OUTCOMES: 1. Preoperative bilateral wrist immobilization with thumb spica braces for three weeks.2. Bilateral open reduction and internal fixation using cannulated headless compression screws and autografts from the left distal radius.3. Continued use of thumb spica braces, daily bone stimulator use, and monthly follow-ups.4. Left wrist healed fully by four months after surgery, while the right wrist showed partial osseous healing with signs of osteonecrosis in the proximal pole, requiring extended immobilization of the right wrist when active.5. Seven months after surgery, the patient had union in both wrists via CT, allowing removal of the right thumb spica cast. Functional wrist movement was demonstrated.