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Occult scaphoid fracture — MCCQE Part 1 MCQ

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ModerateWrist PainOccult scaphoid fractureMCCQE Part 1

A 19-year-old snowboarder falls onto an outstretched hand and has radial-sided wrist pain. Examination shows anatomic snuffbox tenderness and pain with axial thumb loading. Initial wrist x-rays are normal. What is the most appropriate next step in management?

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Correct answer: C — Immobilise in a thumb spica splint and arrange repeat imaging or MRI

Scaphoid fractures can be radiographically occult initially; snuffbox tenderness warrants immobilisation and repeat imaging or MRI to prevent non-union and avascular necrosis. A normal initial x-ray does not exclude fracture. Corticosteroid injection and antibiotics do not address the traumatic presentation.

Reference: Canadian Orthopaedic Association resources; MCC Objectives—Fractures