Name that fracture, ideal imaging modality, and treatment including indication for operative repair:


That would be a classic scaphoid fracture. It should ideally be imaged first with a three-view x-ray (AP, lateral, and scaphoid view – 30 deg extension, 20 deg ulnar deviation), but an MRI is the most sensitive for occult fractures. CT with 1 mm cuts is also acceptable although less sensitive than MRI.

Treatment is typically non-operative with thumb spica cast immobilization. Over 90% of fractures can be managed this way. Indications for operative repair include: proximal pole fractures, displacement > 1 mm, 15 deg scaphoid humpback deformity, radiolunate angle > 15 deg, intra-scaphoid angle of 35 deg, comminuted fractures, unstable vertical / oblique fractures, and any fracture associated with a perilunate dislocation. Duration of casting varies from 3-5 months depending on location of the fracture. Importantly, don’t forget to cast / splint any suspected fracture and refer for prompt follow up for reimaging.

The only question that remains unanswered is how did Matt Egan’s scaphoid become so jacked up…


Abbasi, David, Scaphoid Fracture.

deWeber, Kevin. Scaphoid fractures. Uptodate. Eiff P. Grayzel, J (eds).

Egan, Matt, Scaphoid image