radiological investigation

Last reviewed 01/2018

Radiological investigation is essential in the diagnosis of a scaphoid fracture because the clinical picture is rarely conclusive.

A diagnosis of a "sprained wrist" is permitted only once that of a fractured scaphoid has been excluded.

Four views are required:

• anterior-posterior
• lateral
• two different oblique views

Often, only the oblique view reveals recent fracture, but it is not uncommon for the injury to be overlooked on the initial radiographs.

The appearance of the fracture becomes more obvious after a few weeks:

• a healing fracture is sclerotic
• avascular necrosis of the proximal pole results in increased density

An unstable fracture may be apparent from opening of the fracture line, angulation of the distal fragment, foreshortening of the scaphoid, or dorsal angulation of the lunate.