A 20-year-old female complains of right wrist pain after a...

A 20-year-old female complains of right wrist pain after a fall onto an outstretched hand. Radiographs appear completely normal, but the patient has significant snuffbos tenderness on exam. You suspect a scaphoid fracture. Which of the following is TRUE regarding this injury? (A) A fat pad sign is insensitive for detecting fracture in obese patients. (B) Avascular necrosis can occur if the blood supply to the distal portion of the scaphoid is compromised by the fracture. (C) Clinically suspected scaphoid fractures should be splinted in a short arm thumb spica splint in a dorsiflexed and ulnar-deviated position. (D) Unstable scaphoid fractures (rotated, comminuted, or displaced fractures) should be splinted in a long arm spica splint.

A 20-year-old female complains of right wrist pain after a fall onto an outstretched hand. Radiographs appear completely normal, but the patient has significant snuffbos
tenderness on exam. You suspect a scaphoid fracture. Which of the following is TRUE regarding this injury?
(A) A fat pad sign is insensitive for detecting fracture in obese patients.
(B) Avascular necrosis can occur if the blood supply to the distal portion of the scaphoid is compromised by the fracture.
(C) Clinically suspected scaphoid fractures should be splinted in a short arm thumb spica splint in a dorsiflexed and ulnar-deviated position.
(D) Unstable scaphoid fractures (rotated, comminuted, or displaced fractures) should be splinted in a long arm spica splint.

Key Concepts

Immobilization Techniques for Suspected Scaphoid Fractures

When a scaphoid fracture is suspected clinically even with negative initial imaging, immobilization is typically initiated. A thumb spica splint or cast is used to stabilize the wrist and thumb, thereby reducing movement of the scaphoid. The positioning and type of immobilization may vary, but early immobilization is key to minimizing the risk of complications associated with scaphoid fractures.

Scaphoid Fracture

This refers to a fracture of one of the carpal bones that is commonly seen after a fall onto an outstretched hand. It is frequently diagnosed based on clinical findings such as tenderness in the anatomic snuffbox, even when initial radiographs are normal. The insidious nature of scaphoid fractures makes clinical suspicion important, as early diagnosis is crucial to prevent complications.

Vascular Supply of the Scaphoid

The scaphoid receives its blood supply predominantly from vessels entering at its distal pole, with blood flow proceeding in a retrograde manner to the proximal portion. Because of this unique vascular arrangement, fractures—especially those involving the waist—can risk compromising the blood supply to the proximal segment and potentially lead to avascular necrosis.

Imaging and Diagnosis of Occult Fractures

Occult fractures, such as many scaphoid fractures, can present with normal initial radiographs despite the presence of injury. This necessitates a reliance on clinical findings, supplementary imaging modalities (like MRI or CT), and sometimes a period of immobilization with repeat imaging to avoid missing a fracture.

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