A young man with wrist pain

A 24 year old left handed builder presented to the emergency department after falling on to an outstretched hand two days ago while playing football. Since then he had been experiencing increasing pain in his wrist. He was otherwise fit and well with no medical problems. On examination his wrist was tender in the anatomical snuff box. He was neurovascularly intact distally and had a full range of movement. There was increased pain on dorsiflexion but no obvious swelling, bruising, or deformity. He had no other injuries. A radiograph was taken of his right wrist (fig 1⇓). ### 1 Describe the radiographic image. What is the diagnosis? #### Short answer This is an anterioposterior radiograph of the right wrist showing a fracture of the waist of the scaphoid, which appears undisplaced. #### Long answer This is an anterioposterior radiograph of the right wrist showing a fracture of the waist of the scaphoid, which appears undisplaced. The scaphoid bone lies radially in the proximal carpal row and is the most commonly fractured carpal bone.1 Three fracture sites of the scaphoid are commonly recognised (fig 2⇓): Fig 2 Anterioposterior radiograph of the right wrist showing the three sites of fracture of the scaphoid: (A) a fracture of the tubercle, (B) a fracture through the waist of the scaphoid, and (C) a fracture of the proximal pole The rates at which these sites are fractured are 70%, 20%, and 10%, respectively.2 Although the fracture does not …