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Pyogenic flexor tenosynovitis — RCPSC EM MCQ

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HardMusculoskeletalPyogenic flexor tenosynovitisRCPSC EM

A patient has high clinical suspicion of scaphoid fracture but normal initial radiographs. Early MRI is unavailable and immediate clarification is not required. What is the most appropriate imaging follow-up plan?

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Correct answer: D — Arrange delayed repeat scaphoid radiographs after at least 10 days

The best answer is “Arrange delayed repeat scaphoid radiographs after at least 10 days”. With persistent suspicion and normal initial X-rays, Canadian referral guidance supports delayed radiographs after at least 10 days when early definitive diagnosis is not required. MRI is preferred when immediate clarification is needed and CT may further evaluate occult bony injury. Same-day repeat films, vascular CT, immediate bone scan and ultrasound do not substitute for the recommended fracture pathway.

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