Rosh Emergency Medicine Practice Test

What complication is associated with a wrist injury involving tenderness over the anatomic snuffbox?

1. Compartment syndrome

2. Osteonecrosis

3. Ulnar deviation deformity

4. Ulnar nerve injury

The correct answer is: Osteonecrosis

Tenderness over the anatomic snuffbox is a classic sign associated with a scaphoid fracture, which is a common wrist injury. The scaphoid bone is situated in the proximal carpal chain, and when it is fractured, it can lead to complications such as osteonecrosis due to its poor blood supply. Osteonecrosis occurs because the blood flow to the scaphoid is compromised when the bone is fractured. This can lead to avascular necrosis, where the bone tissue begins to die due to a lack of adequate blood supply. The scaphoid has the potential to become necrotic, particularly the proximal portion, since the blood supply enters from distal to proximal, making avascular necrosis a significant long-term complication of untreated or improperly managed scaphoid fractures. Understanding the risks associated with wrist injuries, particularly those that present with tenderness in the anatomic snuffbox, is crucial in emergency medicine. Recognizing scaphoid fractures early and monitoring for complications like osteonecrosis helps guide appropriate management and treatment interventions.