USMLE PRACTICE QUESTION OF THE WEEK

Question for November 28, 2025

A 26-year-old man falls off his bicycle and lands on his outstretched hand. He has pain at the radial aspect of the wrist and the base of the thumb. There is a point of tenderness in the anatomic snuffbox and pain with axial loading of the thumb. Neurovascular exam of the hand is normal. Initial wrist radiographs reveal no fracture.

Which of the following is the best next step in management?

A. Thumb spica splint and repeat radiographs in 7-10 days

B. Immediate MRI of the wrist

C. Orthopedic surgery consultation

D. NSAIDs and early range-of-motion exercises

E. Short arm cast for 6 weeks

Get Detailed Explanation

Correct Answer:

A. Thumb spica splint and repeat radiographs in 7-10 days

Correct Answer Explanation:

Clinical suspicion for scaphoid fracture (snuffbox tenderness) remains high despite normal initial radiographs due to low early sensitivity. Immobilization in a thumb spica splint with repeat imaging in 7-10 days is recommended. MRI can detect occult fracture but is not mandatory initially if immobilization is feasible. Early motion risks nonunion and avascular necrosis. Routine casting without confirmation may overtreat.

Further Insight:

Blood supply enters distally; proximal fractures have higher avascular necrosis risk.
Delayed diagnosis increases nonunion risk.