[Occult scaphoid fractures: current evidence and diagnostic algorithm]

Scaphoid fractures are frequent but are overlooked in 20-40% of cases on initial radiographs. In so-called occult scaphoid fractures, i.e. clinical scaphoid fractures with negative X‑ray diagnostics, the hand of the patient is often empirically immobilized with a cast and the X‑ray diagnostics repeated 10 days later. Based on the current literature the authors propose a diagnostic algorithm that incorporates various patient characteristics and socioeconomic aspects and suggests a possible follow-up treatment. For high-demand and manually working patients, timely advanced diagnostic imaging may be medically and socioeconomically meaningful. Pensioners and patients with low manual demands, however, can be treated according to the traditional algorithm. Additional use of computed tomography (CT) or magnetic resonance imaging (MRI) diagnostics with or without intra-articular contrast agent might be helpful if concomitant soft tissue injuries are suspected.