Anatomic snuffbox tenderness is a highly sensitive test for scaphoid fracture, whereas scaphoid compression pain and tenderness of the scaphoid tubercle tend to be more specific. Initial radiographs in patients suspected of having a scaphoid fracture should include anteroposterior, lateral, oblique, and scaphoid wrist views.
Initial radiographs do not always detect scaphoid fractures. In one prospective trial,8 the sensitivity of initial radiographs was 86 percent. However, a great deal of variability in the sensitivities (higher and lower) of radiographs is found in the literature. Nondisplaced fractures of this bone are known to be difficult to see on initial radiographs. In these cases, one treatment option includes placing the patient in a cast and performing a follow-up physical examination and repeat radiography in two weeks. Recent improvements in technology may allow alternate approaches in this situation.
(Left) This x-ray shows a scaphoid fracture fixed in place with a screw. (Right) This x-ray was taken 4 months after surgery. The fracture of the scaphoid is healed.