Investigating suspected scaphoid fracture
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1370 (Published 27 March 2013) Cite this as: BMJ 2013;346:f1370
- Randall L Baldassarre, medical student,
- Tudor H Hughes, professor of radiology; vice chair of education; radiology residency program director
- 1Department of Radiology, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8756, USA
- Correspondence to: T H Hughes thughes{at}ucsd.edu
Learning points
Initial evaluation for suspected acute scaphoid fracture requires radiography, but this modality misses 15-20% of fractures
Occult scaphoid fractures may be examined by repeat radiography after casting, magnetic resonance imaging, computed tomography, bone scintigraphy, or ultrasonography
The American College of Radiology recommends magnetic resonance imaging or repeat radiography after 10-14 days of casting as the second line investigations of choice
The choice of imaging modality for occult scaphoid fracture depends on factors such as age, hand dominance, patient activity, cost, and availability of services
A 26 year old previously healthy woman presented to the emergency department immediately after being involved in a road traffic incident. After clinical examination, scaphoid injury was suspected. A radiograph of the left wrist was obtained and found to be equivocal (fig 1⇓).
Fig 1 Posteroanterior radiograph of the wrist showing an incomplete lucency at the waist of scaphoid suspicious for a fracture but not definitive (arrow)
What is the next investigation?
Scaphoid fractures should be suspected with trauma involving the hand and/or wrist, particularly falls onto an outstretched hand and road traffic incidents. Such fractures most commonly occur among men aged 20-30 years, with about 10% presenting with an associated fracture.1 Less than 20% of patients with a clinically suspected scaphoid fracture have a true fracture.2 In most of the patients with true scaphoid fracture, the fracture is diagnosed with wrist radiography, the initial examination recommended by the …
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