Occult scaphoid fracture

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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