Scaphoid fractures are commonly missed . I see at least one missed fracture every month and this is the result of several factors . The signs and symptoms of scaphoid fractures can be unimpressive and frequently patients as well as health care professionals think that the injury is simply a ‘sprain’ . Any fall onto or impact to the wrist (eg goalkeeper saving a football) resulting in pain / aching to the base of the thumb area should be reviewed by a healthcare professional , appropriate imaging performed (scaphoid view XRs or MRI if normal XRs) and protected in a splint until a fracture is excluded .
MRI is the gold standard investigation of choice and XRs can indeed be normal
Most scaphoid fractures will heal uneventfully in a plaster or splint but certain fracture patterns have a tendency to heal slowly or not unite at all . An expert will be able to advise which fractures should be considered for surgery (displaced , proximal pole, unstable oblique). Initial treatment can be straightforward (either supervised plaster immobilisation, simple screw fixation ) but if a scaphoid fracture is missed or diagnosis is delayed , then surgery can be a bit more complex necessitating grafting and fixation . This is why it is important that a prompt and accurate diagnosis is made and and expert opinion obtained .
