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Occult scaphoid fracture — MCCQE Part 1 MCQ

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ModerateFracturesOccult scaphoid fractureMCCQE Part 1

A 19-year-old hockey player falls on an outstretched hand. Wrist radiographs are initially normal, but he has marked tenderness in the anatomic snuffbox and pain with axial loading of the thumb. What is the most appropriate investigation?

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Correct answer: B — Repeat wrist radiographs or MRI after immobilisation for suspected scaphoid fracture

Snuffbox tenderness after FOOSH suggests occult scaphoid fracture despite normal initial radiographs; immobilisation and repeat imaging or MRI are appropriate. No further imaging risks missed fracture, non-union, and avascular necrosis. CT abdomen, urate testing, and nerve conduction studies do not address the suspected carpal injury.

Reference: Canadian Orthopaedic Association wrist injury guidance