1. MedPix Medical Image Database COW - Case of the Week Case Contributor: James M Grimson Affiliation: Naval Medical Center Portsmouth

2. MedPix No: 8700 - History Pt Demographics: Age = 33 y.o. Gender = man 33 year old male fell on outstretched hand. Although initial radiographs were read as suspicious but not definitive for scaphoid fracture, the patient was not re-imaged as recommended. Patient underwent physical therapy for 8 months prior to obtaining an MRI examination. Downloaded by (-1)

3. MedPix No: 8700 - EXAM & LABS Snuffbox tenderness noted, as well as pain with volar flexion.

4. Scaphoid Fracture A faint lucency can be seen at the distal scaphoid. Downloaded by (-1)

5. Scaphoid Fracture A fracture of the distal scaphoid is seen, with low signal intensity in the distal fracture fragments. The proximal scaphoid is normal in appearance. Downloaded by (-1)

6. Scaphoid Fracture A comminuted fracture of the distal scaphoid is seen. The proximal scaphoid is normal in appearance. Downloaded by (-1)

7. Scaphoid Fracture Another view demonstrates a comminuted fracture of the distal scaphoid. The proximal scaphoid is normal in appearance. Downloaded by (-1)

8. FINDINGS The oblique radiograph demonstrates a faint lucency in the distal pole of the scaphoid. The MRI images demonstrate a clear fracture of the distal scaphoid, with fragmentation and some ulnar displacement. The waist and proximal pole of the scaphoid are within normal limits.

9. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Scaphoid fracture, distal pole

10. Diagnosis: Scaphoid Fracture Dx Confirmed by: By these images

11. DISCUSSION None