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 weeks following the injury A missed scaphoid injury can lead to significant morbidity