- See:
Non-Displaced Scaphoid Frx
- Discussion:
- in up to 25% of cases, initial ER radiographs will fail to demonstrate a frx;
- Management Options:
-
immobilization and repeat radiographs:
- w/ positive exam findings and negative radiographs, immobilize wrist in a
thumb-spica cast for 7-10 days;
- as bone resorbs at frx site, radioluncency appears at 7-10 days;
- by that time, usually scaphoid either will not be tender or will have a demonstrable frx on radiographs;
- if tenderness persists and repeat x-rays are neg, immobilization may be continued for an additional 7-10 days;
- alternatively consider, magnification radiographs which can demonstrate interruption of trabeculae (impling occult fracture);
- repeat stress radiographs in ulnar deviation after the wrist joint has been injected with lidocaine;
-
immobilization followed by bone scanning:
- if x-ray continue to be negative after 2nd trial of immobilization &
symptoms persist, then consider a
bone-scan;
-
CT scanning:
- consider obtaining a
CT scan of the scaphoid on the day of injury, if is essential to know the diagnosis (such as w/
a surgeon or an athelete)
Magnetic resonance imaging in scaphoid fractures.
Occult scaphoid fracture: a diagnostic enigma.
