What's the Diagnosis? Case by Erica Schramm

Answer: Non-displaced scaphoid waist fracture

Scaphoid fractures

  • The most common carpal bone fracture (60-70% of all carpal fractures). 10-30% of scaphoid fractures are not detected on the first set of plain films, but “scaphoid view” plain films (i.e., AP wrist with ulnar deviation) can improve the view of the scaphoid
  • If a scaphoid fracture is clinically suspected, the patient should be placed in a thumb spica splint and follow up in 7-10 days for repeat plain films and reexamination
  • The most feared complication of a scaphoid fracture is avascular necrosis (AVN) of the proximal fracture segment. AVN is more likely in unstable scaphoid fractures, for example those that are proximal, oblique, displaced >1 mm, rotated, or comminuted. These require surgical consult and long arm thumb spica splint
  • Stable fractures can be splinted with a short arm thumb spica splint and patients should be instructed to follow up with orthopedics in 7-10 days


  • Escarza, Robert et al. “Chapter 266. Wrist Injuries.” Tintinalli’s Emergency Medicine a Comprehensive Study Guide, 7e.  Eds, Judith E. Tintinalli, et al.  New York, NY: McGraw-Hill, 2011.
  • DeAngelis, Michael A and David A Wald. “Wrist.” Simon’s Emergency Orthopedics, 7e.  Ed. Scott C Sherman.  New York, NY: McGraw-Hill, 2014
  • Jordanov, Martin I and Robert Warne Fitch. “Chapter 9 Upper Extremity.” The Atlas of Emergency Radiology. Eds. Jake Block et al.  New York, NY: McGraw-Hill, 2013