Fractures of the Scaphoid

### What you need to know A 25 year old man sustains an extension injury of his right wrist while playing football as a goalkeeper, and presents to the emergency department the same day with wrist pain. Examination reveals tenderness over the radial side of the wrist, including within the “anatomical snuffbox,” as well as tenderness over the tubercle of the scaphoid. However, he has no pain on longitudinal compression of his thumb. Standard posteroanterior and lateral wrist radiographs are performed ( fig 1 ) and as no fracture is seen, he is discharged. He re-attends six weeks later with ongoing pain, and a series of scaphoid radiographs ( fig 2 ) show a fracture of the proximal third of the scaphoid. Fig 1 Initial radiographs obtained in the emergency department with and without labels. These only included standard (a) posteroanterior and (b) lateral views of the wrist. No scaphoid fracture was visible on these views. Scaphoid (Sc) marked with a dashed white line; trapezium (Tm) marked with dotted white line, and trapezoid (Td) marked with dotted black line Fig 2 Scaphoid views performed six weeks after the injury. Three of the standard scaphoid series are presented including (a) posteroanterior, (b) pronated oblique, and (c) Ziter views. A proximal pole fracture is clearly seen on the pronated oblique and the Ziter views. The fracture is …