What are the common mechanisms of scaphoid fracture?
The usual mechanism is falling on an outstretched hand with resultant hyper-extension of the wrist or purely compressive force. Occasionally stress fractures are also encountered although these are less common, and only usually seen in athletes (e.g. shot-putters or gymnasts).
What are the clinical presentations of scaphoid fracture?
Classically there can be pain in anatomical snuffbox which is thought to have a sensitivity of ~ 90 % and a specificity ~ 40 %
What is the most common diagnostic difficulty of scaphoid fracture?
Plain radiographs of the wrist, including dedicated scaphoid views are the initial imaging modality of choice. It should however be noted that initial radiograph can miss from 5-20% of fractures in the acute setting. Importantly if no fracture is seen it is essential to recommend repeat x-rays (including dedicated scaphoid views) in 7-10 days.
There is increase lucency at the site of fracture in keeping with non-union. In addition the proximal pole is notably more sclerotic in keeping with AVN.