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Scaphoid Frx: Non Diagnositic X-ray

- See: Non-Displaced Scaphoid Frx

- Discussion:
    - in up to 25% of cases, initial ER radiographs will fail to demonstrate a frx;

- Management Options:
    - immobilization and repeat radiographs:
           - w/ positive exam findings and negative radiographs, immobilize wrist in a thumb-spica cast for 7-10 days;
           - as bone resorbs at frx site, radioluncency appears at 7-10 days;
           - by that time, usually scaphoid either will not be tender or will have a demonstrable frx on radiographs;
           - if tenderness persists and repeat x-rays are neg, immobilization may be continued for an additional 7-10 days;
                   - alternatively consider, magnification radiographs which can demonstrate interruption of trabeculae (impling occult fracture);
                   - repeat stress radiographs in ulnar deviation after the wrist joint has been injected with lidocaine;
    - immobilization followed by bone scanning:
           - if x-ray continue to be negative after 2nd trial of immobilization &  symptoms persist, then consider a bone-scan;
    - CT scanning:
           - consider obtaining a CT scan of the scaphoid on the day of injury, if is essential to know the diagnosis (such as w/a surgeon or an 

Magnetic resonance imaging in scaphoid fractures.

Occult scaphoid fracture: a diagnostic enigma.