M8) Fall on an outstretched hand

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with hand pain.
  2. Review the DDx considerations in patients with hand pain.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with hand pain.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
The patient most likely has a scaphoid fracture considering the mechanism of injury (fall on an outstretched arm) and physical exam findings of pain and swelling in the anatomic snuffbox.
Well done. You were correct

Potential Acuity

What is your assessment of the likely acuity for this patient?

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The patient will require prioritized workup and management.

First Imaging Study

What is the first imaging study you will order?

Standard plain films of the wrist including the posteroanterior (PA), true lateral, oblique and scaphoid views are the best initial imaging modality to assess for a suspected scaphoid fracture. They are quick and relatively inexpensive, but may be equivocal in the acute setting.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

No further imaging is needed as the diagnosis is confirmed with the initial hand x-rays.
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What is your Diagnosis now that you have seen the imaging results?

The patient’s history, physical exam, and imaging findings are consistent with a diagnosis of an acute scaphoid fracture. While it may occur if left untreated, there are no signs or imaging findings to suggest avascular necrosis.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

The patient will require prioritized workup and management.

Assessment and Plan

Please provide your assessment and plan for this patient

This patient is a 25-year-old male presenting with an acute, minimally displaced fracture of the proximal pole of his right scaphoid bone. Given the elevated risk for neurovascular compromise and nonunion in a proximal pole fracture, the patient will be referred to a hand surgeon to undergo evaluation for operative intervention.

Lessons Learned:
- Scaphoid fracture is an important diagnostic consideration in a patient with wrist pain following a fall on an outstretched hand.
- Anatomic snuffbox tenderness is the most sensitive physical examination finding for a scaphoid fracture.
- A fracture of the proximal pole of the scaphoid places a patient at an elevated risk of avascular necrosis due to arterial supply to the scaphoid entering distally and feeding proximally.
- X-rays of the hand are the initial imaging modality of choice in a suspected scaphoid fracture.

Socioeconomic Factors: Hand trauma care is considered suboptimal in the United States because of the severe on-call hand-specialist shortage.

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Jordan Turetsky, MS4 - Content Contributor
Khalida Clark - Content Contributor
Kevin Pierre, MD - Editor
Robbie Slater, MD - Supervising Editor
Bayar Batmunh, MS - Coordinator