59 patients with clinical suspicion of scaphoid fracture, but negative radiographs at presentation and review, were examined by magnetic resonance imaging (MRI) and bone scintigraphy (BS). The diagnoses were compared with subsequent follow-up. There were four scaphoid fractures, 10 other fractures and three significant ligamentous injuries. All scaphoid fractures were identified by MRI and BS. MRI showed better interobserver agreement for scaphoid injury than BS and fewer false positive reports. Significant ligamentous injury and carpal instability diagnosed by MRI were not evident on scintigraphy. Using fast scanning protocols, the cost of MRI is comparable with that of BS. MRI should be considered as the appropriate second line investigation in these clinical circumstances.