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. Application of a thumb spica cast and repeat imaging in 2 weeks
C. Prescribe NSAIDs and reassess in 1 week
D. MRI of the wrist
E. Immediate referral for physical therapy
Answer and topic summary
The answer is B. Application of a thumb spica cast and repeat imaging in 2 weeks
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 cast and arrange for repeat imaging in 2 weeks. Scaphoid fractures can be occult on initial X-rays due to swelling or the fracture’s position. Immobilization helps prevent further injury and promotes healing. Repeat imaging after a period allows for the potential visualization of the fracture that may have been initially occult due to bone resorption around the fracture site or decreased swelling, improving radiographic sensitivity.
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Smarty PANCE Content Blueprint Review:
PANCE Blueprint Musculoskeletal -> Upper extremity disorders -> Fractures and dislocations of the forearm, wrist and hand