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

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.