In suspected scaphoid fracture, initial X-rays may be normal. What is the recommended next finding or step?

• A. It may be normal; repeat X-ray in 2 weeks will show the fracture
• B. MRI should be done immediately
• C. Treat as a fracture without imaging for 6 weeks
• D. No imaging is needed if SN pain resolves

Answer: (A)

Occult scaphoid fractures are common when the initial X-ray is normal. The best next step is to immobilize the wrist and obtain repeat radiographs in about 2 weeks, because a fracture line or healing changes often becomes visible by then. In the meantime, keeping the wrist in a thumb spica cast protects the bone from displacement and reduces the risk of complications. If pain or suspicion remains high after immobilization and re-imaging, an MRI can be used to detect an occult fracture earlier, but the standard next step is re-imaging in two weeks.