A patient with tenderness in the anatomical snuffbox after a fall on an outstretched hand likely has a fracture of which bone?

• A. Scaphoid fracture treated with a thumb spica splint and hand surgeon referral
• B. Radius fracture
• C. Lunate fracture
• D. Capitate fracture

Answer: (A)

Tenderness in the anatomical snuffbox after a fall on an outstretched hand points most strongly to a scaphoid fracture. The scaphoid lies in that small hollow on the thumb-side of the wrist, so direct impact or FOOSH commonly injures it. Initial X-rays can be normal, so a high index of suspicion is important even if imaging doesn’t show a fracture right away.

Treatment aims to protect the fracture and prevent complications like nonunion or avascular necrosis, especially since the blood supply to the scaphoid can be disrupted. That’s why immobilization with a thumb spica splint is used and why urgent referral to a hand surgeon is recommended for definitive management, which may involve casting or surgical fixation depending on the fracture type and location.

Other wrist bones listed can fracture from FOOSH as well, but they don’t produce the same peak tenderness in the snuffbox. The pattern here—the snuffbox tenderness after FOOSH—fits best with a scaphoid fracture.