Diagnostic Studies

Initial radiographs included three standard films of the wrist: a posteroanterior (PA) view of the wrist with the forearm in a neutral position, a lateral projection of the wrist, and an oblique view with the forearm in 35 degrees of supination. These films were negative. Follow-up serial films at 4 weeks demonstrated a fracture of the proximal pole of the scaphoid (Fig. 57-1).

Proximal Pole Scaphoid Fracture
Figure 57—1. Posteroranterior view of the hand showing acute proximalpole scaphoid fracture.
Radial Wrist Pain Differential Diagnosis
Figure 57—2. Evaluation of acute radial-sided wrist pain.

The diagnosis of scaphoid fracture is often not straightforward. We have developed an algorithm for the radiographic evaluation of radial wrist pain (Fig. 57-2). Initial evaluation includes the standard set of radiographs. Follow-up of initial studies is demanded for persistent pain. Resorption of bone at follow-up will aid in fracture detection. A bone scan taken 2 to 3 weeks after injury is highly sensitive for fracture or ligamentous injury. A negative scan excludes a fracture. Computed tomography (CT) and magnetic resonance imaging (MRI) are highly specific and sensitive for detection of a scaphoid fracture.

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