Case 5

A 45 year old male presents with a 3 month history of wrist pain which is getting progressively worse. He cannot recall an injury to his wrist. He has normal sensation and capillary refill distally. There is pain with extension of the wrist and tenderness on the dorsal aspect of his wrist just distal to Lister's tubercle. An x-ray of his wrist reveals the following:

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The most likely diagnosis is
avascular necrosis of the lunate.
a fracture of the triquetrum.
a fracture of the scaphoid.
a dislocation of the lunate.