Differential Diagnoses

  • Distal radius fracture
  • Scaphoid fracture
  • Tendinitis
  • Lunate dislocation

                                                                                       Figure 2. 

 
Diagnosis
This patient suffered a scaphoid fracture—one of the most common injuries associated with a fall on outstretched hands (FOOSH).
Learnings/What to Look for

  • Scaphoid fractures are the most common carpal bone fracture. They occur most often in adolescents and young adults
  • The fracture location is most often through the waist
  • Examine the anatomical snuff box and if there is pain, consider a scaphoid fracture
  • These injuries may be subtle or occult. If there is strong clinical suspicion after a negative XR, consider MRI.

Pearls for Urgent Care Management and Considerations for Transfer

  • Imaging should include multiple views, including lateral, PA, oblique, and ulnar deviation
  • Suspicion of scaphoid fracture should be treated as a confirmed fracture until proven otherwise
  • The patient should be placed into a thumb spica splint before discharge
  • Follow up should be in 5-7 days with repeat imaging if subjective or objective pain persists

Acknowledgment: Images courtesy of Teleradiology Specialists.

A 15-Year-Old Boy with Wrist Pain After a Fall
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