Management of clinical fractures of the scaphoid: results of an audit and literature review

Abstract

The incidence of radiologically inapparent fractures of the scaphoid is low. The use of a tender anatomical snuff box as the only clinical sign in the diagnosis of scaphoid injury is unsatisfactory. Other injuries around the wrist must be carefully excluded. There is insufficient evidence to support immobilizing all patients with clinical scaphoid fractures. For suspected fractures with no radiological evidence, symptomatic treatment is probably sufficient. Most occult fractures are visible at 2 weeks. Both magnetic resonance imaging and bone scintigraphy are accurate and cost effective and should be performed earlier rather than later.