A 30-year-old woman falls from a height and lands on her outstretched hand. She presents with pain and swelling in her right wrist. X-ray shows a scaphoid fracture, but the initial X-ray was normal. What is the next best step? A) Repeat X-ray in 10-14 days B) Discharge with simple analgesia C) Immediate MRI of the wrist D) CT scan of the wrist E) Refer for urgent surgical fixation Correct Answer: A) Repeat X-ray in 10-14 days Explanation: Scaphoid fractures are often missed on initial X-rays due to minimal displacement. If suspicion remains, the patient should be treated as a scaphoid fracture → wrist splint + repeat X-ray in 10-14 days. MRI is only needed if high suspicion remains after 2nd X-ray. B) Discharge with simple analgesia → Incorrect. Risk of non-union and avascular necrosis. C) Immediate MRI → Incorrect. Not first-line unless X-rays remain inconclusive after 2 weeks. D) CT scan → Incorrect. MRI is better for soft tissue injuries and occult fractures. E) Urgent surgical fixation → Incorrect. Surgery is reserved for displaced fractures. Key Tips for PLAB 1: ✅ Scaphoid fracture: Normal initial X-ray? → Repeat in 10-14 days ✅ Immobilize wrist in the meantime ✅ High risk of avascular necrosis due to retrograde blood supply
