1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Stephen T Sears Affiliation: Naval Medical Center San Diego

2. MedPix No: History
Pt Demographics: Age = 21 y.o. Gender = man Patient with right wrist pain after a fall while snowboarding.
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3. MedPix No: EXAM & LABS
Right *snuff box* tenderness to palpation.

4. Right wrist
Plain film of the right wrist demonstrates scaphoid waist fracture with smooth margins and slight sclerosis of the proximal pole.
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5. Right Wrist plain film 2
There is a fracture of the scaphoid waist with slight displacement of the distal fragment, slight sclerosis of the proximal pole and widening of the scapholunate space.
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6. Rt Wrist T1 Pre GAD
There is a scaphoid waist fracture with anterior displacement of the distal fragment. The signal characteristics of the distal and proximal fragments are similar.
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7. Post Gad Right Wrist
Post gadolinium, increased enhancement is present in the distal pole, likely associated with hyperemia and edema, while the proximal pole does not enhance.
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8. FINDINGS Plain films demonstrate a scaphoid waist fracture with smooth margins, slight displacement of the distal fragment, and increased sclerosis of the proximal fragment. There is an increased scapholunate joint space consistent with disruption of the scapholunate ligament.MRI pre and post-gadolinium demonstrates scaphoid waist fracture with anterior displacement of the distal fragment, increased enhancement of the distal scaphoid fragment (likely from hyperemia and edema) and lack of enhancement in the proximal pole consistent with avascular necrosis.

9. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

10. Diagnosis: Scaphoid fracture Dx Confirmed by:

11. DISCUSSION