Occult scaphoid fracture

Case contributed by Dr Heather Pascoe

Presentation

Pushbike accident. Pain right wrist.

Patient Data

Age: 20
Gender: Female
X-ray

No fracture of the distal radius or ulnar or carpal bones.

MRI

Due to going pain and clinical suspicion of a scaphoid fracture, MRI was performed 7 days later.

There is non-displaced fracture through the waist of the scaphoid. The scapholunate ligament is intact. No evidence of scapholunate dissociation or DISI deformity.

Note that the coronal images are displayed with the scaphoid to the left of the screen.

X-ray

Xray was performed 6 weeks later prior to fracture clinic review. A healing scaphoid waist fracture is now visible. No evidence of avascular necrosis.

Case Discussion

Scaphoid fractures may be occult on x-ray. If there is clinical concern for a scaphoid fracture when x-rays are normal the patient may be immobilized for 7-10 days and x-rays repeated, or a CT or MRI may be ordered. MRI is the most sensitive of these tests in the first few days.

It is important that a scaphoid fracture is not missed as untreated fractures are at risk of non-union that can lead to scaphoid nonunion advanced collapse (SNAC) wrist. They are also at risk of avascular necrosis of the proximal pole.  Scapholunate advanced collapse (SLAC) may occur if there is associated ligamentous injury.

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Case information

rID: 62179
Published: 5th Aug 2018
Last edited: 10th Aug 2018
Inclusion in quiz mode: Included

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