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Occult scaphoid fracture — RCPSC EM MCQ

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HardMusculoskeletalOccult scaphoid fractureRCPSC EM

A 29-year-old falls on an outstretched hand and has snuffbox tenderness with normal initial scaphoid radiographs. Early definitive diagnosis is needed because they work at height. Which imaging test is preferred next?

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Correct answer: C — MRI of the wrist to identify an occult scaphoid fracture

The best answer is “MRI of the wrist to identify an occult scaphoid fracture”. Normal initial radiographs do not exclude a scaphoid fracture. Canadian imaging guidance supports MRI when early clarification is needed, with CT as an alternative for further bony assessment and delayed radiographs reasonable when early diagnosis is not required. Same-day repeat plain films, soft-tissue ultrasound, immediate bone scan and CT angiography do not provide the appropriate occult-fracture pathway.

Reference: Canadian Association of Radiologists: Trauma Imaging Referral Guideline: https://car.ca/wp-content/uploads/2025/03/CAR_Trauma_Referral_Guideline.pdf