A 30-year-old falls on a dorsally flexed wrist. X-ray shows a scaphoid fracture at the waist. MRI confirms no displacement and normal vascularity of the proximal pole. What is the most appropriate initial management?
- A Immediate percutaneous headless compression screw fixation
- B Below-elbow thumb spica cast for 8–12 weeks ✓
- C Above-elbow cast including thumb for 6 weeks then below-elbow cast
- D Surgical exploration and bone grafting
Correct answer: B. Below-elbow thumb spica cast for 8–12 weeks
Explanation
An undisplaced scaphoid waist fracture with intact vascularity can be managed conservatively with below-elbow thumb spica cast for 8–12 weeks, which achieves union in ~90–95% of cases. Above-elbow casting is no longer recommended as it does not improve union rates but increases morbidity. Percutaneous screw fixation is an alternative for athletes wanting earlier return to sport or for displaced fractures (>1 mm). Bone grafting is reserved for avascular necrosis or established non-union. The waist is the commonest fracture site and is the watershed zone of blood supply.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.