Don’t believe Scaphoid unless you have seen it all

This case is a part of our resident-professor series, by Dr MGK Murthy.  This algorithm is not based on text books and is our own clinical experience.

Is this fracture?

No it looks like  calcification on other views

Now is this Fracture?

Yes it is fracture of tubercle though the other oblique is not suggestive

 Why is that?

 In the second case  there was anatomical snuffbox tenderness and  it is of utmost importance even in todays digital world

What do we suggest to clinician?

Dr Murthy recommends to all clinicians,

·         If X ray is abnormal and tenderness then it is fracture definite

·         If x ray is positive and no tenderness snuff box then think of old fracture or calcification particularly  stress related and degenerative, MRI would solve riddle

·         If tenderness is there and X-ray is normal, still believe tenderness and go for  MRI or nuclear scan

·         If no tenderness and  Xray is suspicious then do other side to see anatomical variations

·         If both are negative then look  for other causes of pain and MRI will help.