Scaphoid Fractures

History: Trauma, endorsing pain on exam

Not the greatest AP, but so far nothing spectacular.

Is that the most common fracture of the carpus?

Not helpful lateral, but necessary and very well positioned. Wonder if there is a navicular aka scaphoid view?

Goodness that's just barely helpful. 
 

Scaphoid fractures are the most common carpal fracture, and it's not particularly close. 

So, when you get acute traumatic wrist pain XRs, be sure to spend just a little extra time outlining the scaphoid cortex and especially looking for a lucent line through the waist, given that is the most common scaphoid fracture.   
 

Be thankful if you have a navicular view BUT be sure to review the oblique view thoroughly - I've had a couple cases where it's best seen there.  Scaphoid/Navicular view is the PA with ulnar deviation below. The whole idea is to elongate the silhouette of the bone and remove bony superimposition. 

(Apparently, they once called the scaphoid "the carpal navicular". Also be thankful we don't do that anymore).

Maybe a little offset at the peripheral cortex to go along with that lucent line. 

Actually less conspicuous on the Navicular view, but there.

Quick side note: Don't get hung up on that tubercle near the waist along the periphery.  That is a normal bump at the transition between radioscaphoid articular surface and non-articular bone. 

If you're still feeling iffy, be 100% unafraid to get that CT if your spidey sense is tingling.

Things to remember:

• Any acute wrist injury, play your odds and pay extra attention to the scaphoid (in addition to the distal radius and ulnar styloid).
• Because they are both elongated views of the bone, think of the oblique view as a poor man's scaphoid view. 
• If it feels ego-dystonic to say WNL, get a CT.