Suspected occult scaphoid fracture — MRCEM SBA MCQ

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EasyProcedures, imaging and diagnosticsSuspected occult scaphoid fractureMRCEM SBA

A 29-year-old man attends the emergency department after falling onto his outstretched right hand. He has focal tenderness in the anatomical snuffbox and over the scaphoid tubercle. There is no deformity or neurovascular deficit. Wrist and dedicated scaphoid radiographs have been reported as showing no fracture. His wrist has been immobilised in a splint. MRI is available the next day, and he has no contraindication to it. Which imaging investigation should be arranged next?

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Correct answer: C — MRI of the wrist the next day

The fall mechanism and focal tenderness at two scaphoid sites sustain clinical suspicion of a scaphoid fracture despite normal initial radiographs. NICE advises considering MRI as first-line imaging after a thorough clinical examination when scaphoid fracture is suspected. Because MRI is available the next day and there is no contraindication, it is the best investigation here. He can remain in the splint while awaiting imaging and review of the result. ([nice.org.uk](https://www.nice.org.uk/guidance/ng38/chapter/Recommendations)) A is a traditional follow-up approach, but it delays clarification when early MRI is accessible. B is a reasonable alternative if MRI is unsuitable or unavailable; neither limitation applies here. D may assess selected soft-tissue injuries but is not the recommended investigation for this suspected occult fracture. E has been used to investigate occult fractures, but offers no advantage over the available MRI in this pathway. A normal first X-ray therefore does not justify treating this as a simple wrist sprain. ([nice.org.uk](https://www.nice.org.uk/guidance/ng38/chapter/Recommendations))

Reference: Fractures (non-complex): assessment and management, recommendation 1.2.3 (17 February 2016) — https://www.nice.org.uk/guidance/ng38/chapter/Recommendations Suspected Scaphoid Fracture Advice (Reviewed 4 June 2025) — https://www.leedsth.nhs.uk/patients/resources/suspected-scaphoid-fracture-advice/