Scaphoid Fractures: How to Treat Symptomatic Patients with a Normal X-Ray and When Should We Operate on Acute Fractures?

The scaphoid is the most injured carpal bone, with an incidence of 12 per 100,000 per annum in the United Kingdom (UK). Fractures of the scaphoid can be challenging to diagnose, both clinically and radiographically, and have a propensity to fail to unite or develop necrosis. There is debate regarding whether to manage acute fractures conservatively or offer early surgical fixation. The poor predictive value of initial examination and plain imaging not only results in missed fractures but also, conversely, in a fivefold overtreatment, which has subsequent significant socioeconomic consequences. It is estimated that between 1995 and 2010, claims relating to the mismanagement of scaphoid fractures cost the National Health Service in the UK £3.5 million. This review will focus on two main controversies in the diagnosis and treatment of scaphoid fractures: how to manage a symptomatic patient with a negative X-ray and which fractures warrant acute surgical fixation? Level of Evidence: Level V (Therapeutic).