The scaphoid fracture

When scaphoid fractures are missed, the consequences for patient and clinician may be considerable. This may be as a consequence of nonunion and if so, reconstructive surgical fixation often with bone grafting may be required. Other longer-term implications such as post-traumatic osteoarthritis (often referred to as scaphoid nonunion advanced collapse - SNAC wrist) may necessitate salvage surgery such as partial or total wrist fusion. In either of these circumstances the cost to the individual for their employment and to the wider health economy will be keenly felt. This article is intended to bring together some of the recent relevant literature on the missed scaphoid fracture and to present a current medico-legal case which illustrates the importance of repeated examination, good records and keeping the possibility of a scaphoid fracture in mind. Wrist pain after injury is very common. The fall onto the outstretched hand is the most typical method of injury, but a direct blow to the hand, such as from a football, may provide sufficient force to fracture the scaphoid. All medical staff in contact with such patients, whether in Minor Injury Units (MIUs), Emergency Departments (EDs), GP surgeries or other primary care providers, need to have high clinical suspicion and must maintain good examination records. The key examination points of the painful wrist should document anatomical snuffbox tenderness (ASB), longitudinal compression of the thumb (LTC), scaphoid tubercle tenderness (STT) and painful ulnar deviation of the wrist (PUD).1 Each of these …