snuffbox tendernessWhat is the most commonly fractured carpal bone in adults? It’s the scaphoid bone. As a bonus it has the dreaded complication of avascular necrosis. So how good are the physical exam and imaging modalities in diagnosing a fracture? What is the likelihood ratio (LR) that snuffbox tenderness predicts a fracture? Bottom lines: The exam is highly sensitive but poorly specific, such that one can only confidently state that a NON-tender snuffbox and scaphoid tubercle essentially rule out an acute scaphoid fracture. Also negative x-rays for patients with scaphoid tenderness still yield a fracture post-test probability of 25%. This PV card breaks down all the LRs.1

PV Card: Scaphoid Fracture


Adapted from 1
Go to the ALiEM Cards site for more resources.

1.
Carpenter C, Pines J, Schuur J, Muir M, Calfee R, Raja A. Adult scaphoid fracture. Acad Emerg Med. 2014;21(2):101-121. [PubMed]
Sean Kivlehan, MD MPH

Sean Kivlehan, MD MPH

Associate Director
International Emergency Medicine Fellowship
Department of Emergency Medicine
Brigham and Women's Hospital
Harvard Medical School
Sean Kivlehan, MD MPH

@Sean_Kivlehan

International Emergency Medicine at @BrighamWomens Hospital & @harvardmed, @EmsWorldNews Advisory Board Member, and former NYC Paramedic
Sean Kivlehan, MD MPH

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