Case 7

A 50 year old male presents with a long history of wrist pain. He recalls an injury to his wrist several years ago for which he did not seek medical attention. He has limited movement of his wrist and tenderness in the anatomic snuffbox. X-ray reveals the following:

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What is the most likely diagnosis?
  
Scapholunate dissociation
Avascular necrosis of the scaphoid
Trapezoid fracture
Trapezium fracture