Scaphoid Fracture: The Daily PANCE Blueprint
A 23-year-old male presents to the emergency department after falling onto his outstretched hand during a basketball game. He complains of pain in the anatomical snuffbox and difficulty gripping objects. Initial plain radiographs of the wrist are negative for fracture. What is the most appropriate next step in the management of this patient's suspected scaphoid fracture?
A. Immediate open reduction and internal fixation
B. Thumb spica immobilization with early MRI or repeat radiographs in 7 to 14 days
C. Prescribe NSAIDs and reassess in 1 week
D. Short arm cast and repeat radiographs in 4 weeks
E. Immediate referral for physical therapy
Answer and topic summary
The answer is B. Thumb spica immobilization with early MRI or repeat radiographs in 7 to 14 days
In cases of a suspected scaphoid fracture with initial negative radiographs, the most appropriate next step is to immobilize the wrist in a thumb spica splint or cast and confirm the diagnosis with early MRI, the preferred advanced test when available, or with repeat radiographs in 7 to 14 days. Initial X-rays miss a substantial share of scaphoid fractures (roughly 20 percent or more), so snuffbox tenderness after a fall on an outstretched hand is treated as a fracture until imaging excludes it. A short arm cast does not immobilize the thumb, and 4 weeks is too long to wait; a missed fracture risks nonunion and avascular necrosis of the proximal pole, whose blood supply flows retrograde from the distal end.
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Smarty PANCE Content Blueprint Review:
PANCE Blueprint Musculoskeletal -> Upper extremity disorders -> Fractures and dislocations of the forearm, wrist and hand