Diagnosis and management of scaphoid fractures

Scaphoid fracture is a common injury encountered in family medicine. To avoid missing this diagnosis, a high index of suspicion and a thorough history and physical examination are necessary, because early imaging often is unrevealing. Anatomic snuffbox tenderness is a highly sensitive test for scaphoid fracture, whereas scaphoid compression pain and tenderness of the scaphoid tubercle tend to be more specific. Initial radiographs in patients suspected of having a scaphoid fracture should include anteroposterior, lateral, oblique, and scaphoid wrist views. Magnetic resonance imaging or bone scintigraphy may be useful if the diagnosis remains unclear after an initial period of immobilization. Nondisplaced distal fractures generally heal well with a well-molded short arm cast. Although inclusion of the thumb is the standard of care, it may not be necessary. Nondisplaced proximal, medial, and displaced fractures warrant referral to an orthopedic subspecialist.