A 35-year-old man presents with pain and tenderness over the anatomical snuffbox after a fall on his outstretched hand. X-ray is reported as normal. The most appropriate next step is:

• A Reassure and discharge with analgesics
• B Repeat X-ray at 2 weeks only if pain persists
• C Immediate operative exploration of the snuffbox
• D MRI or CT scan to detect occult scaphoid fracture ✓

Explanation

Scaphoid fractures are notoriously missed on initial plain radiographs in up to 20% of cases because the fracture line may not be visible for 10–14 days until bone resorption occurs. Anatomical snuffbox tenderness in the clinical context of a FOOSH injury mandates imaging with MRI (most sensitive) or CT to exclude occult fracture, especially given the risk of avascular necrosis of the proximal pole if treatment is delayed. Waiting risks non-union and AVN.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.