Int J Emerg Med (2010) 3:45–47 DOI 10.1007/s12245-009-0138-3 BRIEF RESEARCH REPORT Initial management of potential occult scaphoid fracture in Australasia Anne-Maree Kelly Received: 18 February 2009 / Accepted: 4 November 2009 / Published online: 4 February 2010 # Springer-Verlag London Ltd 2010 Abstract Aim To characterise current management of adult patients with possible occult scaphoid fracture in Australasian emergency departments. Methods Internet-based survey of Directors of Emergency Medicine Training throughout Australasia. Data collected included the most common management used in ED for patients with possible occult scaphoid fracture and whether there was a guideline regarding management of such cases. Data are reported as descriptive statistics. Results 61 responses were received (response rate 73%). The most common management reported was immobilisa- tion in a backslab (23, 38%) or full cast (19, 32%) with clinical assessment and re-X-ray in 7–10 days. CT scan within 7 days was used by 9 (15%), bone scan within 7 days by 6 (10%) and MRI within 7 days by 3 (5%). Very few sites were using same day/next day CT or MRI. Eighty- three percent of sites reported not having a guideline/ protocol for this condition. Conclusion The traditional approach to management of possible occult scaphoid fracture of immobilisation with re- X-ray at 7–10 days remains the most commonly used in Australasia, despite evidence that this is probably over- treatment with significant consequences for patients. The place of advanced imaging for investigation of potential scaphoid fractures requires further research. Keywords Scaphoid . Fracture . Management . Imaging A.-M. Kelly (*) Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Australia e-mail: anne-maree.kelly@wh.org.au Introduction Management of suspected scaphoid fractures with normal X-rays at emergency department (ED) presentation is a common clinical challenge. There has long been concern that failure to identify and immobilise a scaphoid fracture might result in avascular necrosis or non-union with significant functional impact for the patient and potential medico-legal risk for the practitioner. Traditional manage- ment would see the patient immobilised in a plaster cast for 7–14 days followed by clinical examination and re-X-ray to identify fractures not visible on the initial films [1]. That approach can been challenged on two fronts: whether cast immobilisation while awaiting clinical review is justified and the role of alternative imaging modalities at or near the time of initial presentation. Little is known about current practice patterns across Australasian ED for this condition. The aim of this project was to characterise current management of adult patients with possible occult scaphoid fracture in Australasia. Methods This was an Internet-based survey of Directors of Emer- gency Medicine Training (DEMT) throughout Australasia as identified from the Australasian College for Emergency Medicine web-site (www.acem.org.au). DEMTs are the designated supervisors of specialist training at hospitals accredited for training, both metropolitan and rural (one/ hospital). As such, they are easily identifiable, experienced specialists with a good understanding of clinical practice within the ED in which they work. Participants were sent an invitation to participate in the confidential on-line survey by