Scaphoid Fracture Diagnosis and Treatment

Initial Diagnostic Confirmation

The American Academy of Orthopaedic Surgeons recommends beginning with standard 3-view wrist radiographs, including posteroanterior, lateral, and 45° semipronated oblique "scaphoid view", for initial diagnostic confirmation of scaphoid fractures 1, 2
If radiographs are negative but clinical suspicion remains high, the American College of Radiology suggests proceeding directly to MRI without IV contrast, which has 94.2% sensitivity and 97.7% specificity for occult fractures 1, 2
CT without IV contrast is an acceptable alternative to MRI if it is contraindicated or unavailable, particularly useful for evaluating bone cortex detail 1, 2

The American Academy of Orthopaedic Surgeons advises against relying solely on anatomical snuffbox tenderness for diagnosis, as 80% of patients with this finding have no definite bony injury, leading to unnecessary immobilization 1, 2
Concomitant ligamentous injuries, such as scapholunate or lunotriquetral ligament tears, require MRI for detection and may change management, according to the American College of Radiology 1, 2
Inadequate radiographic views should be avoided, with a minimum of 3 views required to avoid missed diagnosis, as recommended by the American College of Radiology 2, 4
Proximal pole fractures carry a higher risk of avascular necrosis due to retrograde blood supply and warrant closer monitoring, according to the American Academy of Orthopaedic Surgeons 2

The Journal of the American Academy of Orthopaedic Surgeons recommends instructing patients to perform active finger motion exercises throughout cast treatment to prevent finger stiffness, which is one of the most functionally disabling complications 3