## Distinguishing Scaphoid Fracture from Contusion ### Clinical Presentation Overlap Both scaphoid fractures and contusions present with anatomical snuffbox tenderness, swelling, and pain on FOOSH injury. Plain radiographs are often normal in both acute presentations, making clinical differentiation challenging. ### Key Discriminating Feature **Key Point:** The persistence of symptoms beyond 2 weeks combined with positive advanced imaging (MRI or CT) is the best discriminator between scaphoid fracture and simple contusion. **High-Yield:** Scaphoid contusions typically resolve within 1–2 weeks with conservative management, whereas fractures demonstrate: - Persistent pain and functional limitation beyond 2 weeks - Positive MRI findings (bone marrow edema, fracture line) - Continued snuffbox tenderness - Failure to improve with rest and immobilization ### Clinical Timeline | Finding | Scaphoid Contusion | Scaphoid Fracture | |---------|-------------------|-------------------| | Resolution | 1–2 weeks | Weeks to months | | MRI findings | Soft tissue edema only | Bone marrow edema ± fracture line | | Plain X-ray (acute) | Normal | Often normal initially | | Plain X-ray (2–3 weeks) | Normal | May show fracture line | | Functional recovery | Rapid | Prolonged | **Clinical Pearl:** MRI is the gold standard for early detection of occult scaphoid fractures (sensitivity >95%) and can definitively distinguish fracture from contusion within 48–72 hours of injury. **Mnemonic:** **SCAPHOID FRACTURE = Slow healing, Continued pain, Advanced imaging positive, Persistent dysfunction, Hyperemia on imaging, Osteonecrosis risk** — all features that separate it from simple contusion. 
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.