What's the Diagnosis? By Dr. Erica Schramm

25 year-old female presents following a fall from her horse 5 days ago. She complains of severe pain in the radial aspect of her right wrist and has no other injuries. Plain films at an outside ED immediately following the injury were negative and repeat plain films are shown here.  What's the diagnosis?  (scroll down for answer) 



Answer: Non-displaced scaphoid waist fracture

  • 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 (AP wrist with ulnar deviation) can improve view of the scaphoid
  • If 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 re-examination
  • 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 > 1mm, 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