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FIGURE 109.15 Radiographs of the thumb depicting a Bennett fracture. (Courtesy of
Children’s Orthopaedic Surgery Foundation.)

Initial Assessment and Management
Physical examination requires attention to edema, range of motion, and point
tenderness to localize carpal injuries. Snuffbox tenderness is a useful tool for
detecting scaphoid fractures. Pain with axial thumb compression can also be a
sign of scaphoid injury. Radiographs are obviously limited in infancy and early
childhood because of the lack of ossification. As the patient ages and the carpals
are progressively ossifying, comparison with the contralateral side may be of
benefit. Dedicated scaphoid views or computed tomography may help to identify
some fractures not seen on routine hand or wrist films. Nondisplaced scaphoid
fractures may not be obvious on initial x-rays but will be visible on repeat
imaging performed 2 weeks following the injury. A missed scaphoid injury can
lead to significant morbidity.