When radiographs are inconclusive for a suspected scaphoid fracture, which imaging modality is most sensitive?

• A. X-ray
• B. MRI
• C. CT
• D. Ultrasound

Answer: (B)

When there’s a suspicion of a scaphoid fracture but X-rays don’t show a fracture, MRI stands out because it can detect bone marrow edema and subtle fracture lines that radiographs miss. This makes MRI highly sensitive for occult injuries, allowing early diagnosis and appropriate immobilization to reduce the risk of nonunion or avascular necrosis. CT is excellent for detailing cortical disruption and fracture geometry, but it’s less sensitive for a hidden fracture in the acute phase. Ultrasound has limited utility in visualizing scaphoid fractures due to deep wrist anatomy, and plain X-rays can be normal early on. If suspicion remains after initial radiographs, an MRI within the first few days provides the most reliable confirmation.