Review Question - QID 106417

The patient’s presentation is consistent with scaphoid fracture. Management of a suspected scaphoid fracture with negative plain radiographs usually involves immobilization with a cast and re-imaging in 7-10 days.

Scaphoid fractures most commonly occur following a fall onto an outstretched hand. Small fractures can be difficult to see on plain films, so management decisions often are made based on clinical evaluation with the history and physical exam. Focal tenderness may be present in the anatomic snuffbox, volar prominence at the distal wrist crease, and distal to Lister’s tubercle. Swelling may be present, and range of motion may be limited. Surgery is indicated for open fractures and for patients presenting with neurovascular compromise.

Figure A shows where the anatomic snuffbox is located. Illustration A is a radiograph with a typical scaphoid fracture (arrow) seen on anteroposterior view.

Incorrect answers:
Answer 1: CT scan of the hand is not indicated at this time.
Answer 2: Ultrasonography typically is not helpful in diagnosing fractures.
Answer 3: Repeating the radiograph immediately will typically not provide useful diagnostic information.
Answer 4: Discharge without immobilization is not indicated in a patient with a suspected scaphoid fracture. Without treatment, the fracture may not heal properly and might lead to non-union, avascular necrosis, and post-traumatic arthritis.