ConditionInjuries & poisoning
Carpal Fractures (Broken Wrist Bones)
Carpal fractures are breaks in one of the eight small carpal bones that form the wrist, between the forearm and the hand. The scaphoid, on the thumb side, is broken most often, usually from a fall on an outstretched hand. These fractures can look like a sprain, and early X-rays often miss them. Because some carpal bones have a fragile blood supply, an untreated fracture may not heal and can lead to arthritis, so a wrist with tenderness at the base of the thumb should be treated as a fracture until proven otherwise.
Also called: Carpal bone fracture, broken wrist bone, scaphoid fracture, wrist bone fracture
At a glance
- What it is
- A break in one of the 8 carpal bones of the wrist.
- Most common
- Scaphoid (about 60 to 70% of carpal fractures), then triquetrum and hamate.
- Typical cause
- A fall on an outstretched hand, sports injuries or road crashes.
- Key sign
- Tenderness in the "anatomical snuffbox" at the base of the thumb.
- Treatment
- Cast or splint for 6 to 12 weeks, or surgery with a screw for displaced or slow-healing fractures.
When to get help
Call 911 or go to the ER
- An obviously deformed wrist, bone through the skin, or a hand that is cold, pale or numb
- Severe wrist swelling with rapidly increasing pain and tight skin
See a doctor within a day or two
- Wrist pain after a fall on an outstretched hand, especially tenderness at the base of the thumb
- Painful, limited wrist movement or weak grip after an injury
- Numbness or tingling in the thumb, index and middle fingers after a wrist injury
- Pain in the palm at the base of the little finger after a golf, baseball or racket sport impact
Book a routine appointment
- A "sprained" wrist that is still painful or stiff after 2 weeks
- Ongoing wrist pain months after an old injury
What to do right away
- Stop using the hand and remove rings before swelling increases.
- Support the wrist in a splint or sling made from a rolled magazine or towel.
- Apply ice wrapped in a cloth for 15 to 20 minutes.
- Keep the hand raised above heart level.
- Get assessed the same day, especially if the base of the thumb is tender.
The carpal bones
The eight carpal bones sit in two rows:
- Near the forearm (proximal row): scaphoid, lunate, triquetrum, pisiform
- Near the hand (distal row): trapezium, trapezoid, capitate, hamate
They allow the wrist's complex movements. The scaphoid bridges both rows, which makes it vulnerable.
Types of carpal fracture
| Bone | How common | Typical cause and clues |
|---|---|---|
| Scaphoid | Most common | Fall on outstretched hand; snuffbox tenderness; high risk of non-union |
| Triquetrum | Second most common | Fall or twisting injury; pain on the little-finger side of the back of the wrist |
| Hamate (hook) | Uncommon | Impact from a golf club, bat or racket handle; pain in the palm; may irritate the ulnar nerve |
| Lunate | Uncommon | High-energy injury; risk of avascular necrosis |
| Trapezium, capitate, pisiform, trapezoid | Rare | Direct blows or with other wrist injuries |
Carpal fractures can also occur with dislocations, such as perilunate dislocation, a serious injury that needs urgent surgery.
Symptoms
- pain and swelling in the wrist, often less dramatic than a forearm fracture
- tenderness at a specific point
- pain gripping, pinching or bending the wrist
- bruising
- reduced wrist movement and grip strength
- sometimes numbness from nerve irritation
A scaphoid fracture can feel like a mild sprain, so people often delay seeking care.
Diagnosis
The doctor checks for tenderness in the anatomical snuffbox, the hollow at the base of the thumb on the back of the wrist, and on the scaphoid tubercle in the palm. Pain when pushing the thumb along its length is another clue.
- X-rays: several views of the wrist, including special scaphoid views. Up to about 1 in 5 scaphoid fractures are not visible on the first X-rays.
- MRI: the most accurate test for a hidden (occult) fracture, increasingly done early.
- CT scan: shows fracture detail and healing, and is good for hamate hook fractures.
If X-rays are normal but a scaphoid fracture is suspected, the wrist is placed in a splint and an MRI or repeat X-rays are arranged within about 10 to 14 days.
Treatment
Non-surgical
Undisplaced fractures, especially in the waist or far end of the scaphoid, are treated in a cast or splint:
- scaphoid: typically 6 to 12 weeks, depending on the fracture location
- triquetrum and most others: about 4 to 6 weeks
Healing is checked with X-rays or CT before the cast comes off.
Surgery
Surgery is recommended for:
- displaced fractures
- fractures of the proximal (near) pole of the scaphoid, which have the poorest blood supply
- fractures with ligament injury or dislocation
- non-union, when the bone has not healed
- hamate hook fractures causing ongoing pain, often treated by removing the fragment
- athletes and manual workers who want a faster return
A small screw fixes the scaphoid through a short incision. Bone grafts are used for non-union.
Rehabilitation
Hand therapy after immobilization restores movement and grip strength. Full recovery can take 3 to 6 months.
Complications
- Non-union: the bone fails to heal, particularly with scaphoid fractures that are untreated, displaced or in smokers.
- Avascular necrosis: loss of blood supply causes part of the bone to die, especially the proximal scaphoid and lunate.
- Post-traumatic arthritis: a scaphoid non-union can lead to a pattern of wrist arthritis called SNAC wrist.
- Stiffness and reduced grip.
- Nerve irritation: carpal tunnel syndrome or ulnar nerve symptoms with hamate fractures.
- Complex regional pain syndrome: uncommon.
Outlook
When diagnosed and treated early, about 90% or more of scaphoid waist fractures heal with casting. Results are excellent after successful healing. Delayed diagnosis increases the risk of non-union and long-term wrist problems.
Frequently asked questions
What is a carpal fracture?
A carpal fracture is a break in one of the eight small bones of the wrist. The scaphoid, on the thumb side, is the most commonly broken. These fractures usually happen when falling onto an outstretched hand.
How do I know if I broke a bone in my wrist?
Signs include wrist pain and swelling after a fall, pain gripping or pinching, tenderness at the base of the thumb and reduced movement. A broken carpal bone can feel like a sprain, so get an X-ray if pain persists or the base of the thumb is tender.
Why do scaphoid fractures not show on X-rays?
Scaphoid fractures can be very fine, and the bone's shape makes them hard to see on standard views. Up to about 1 in 5 are missed on the first X-rays. MRI or repeat X-rays after 10 to 14 days usually reveal them.
How long does a carpal fracture take to heal?
Most carpal fractures heal in 6 to 12 weeks. Scaphoid fractures near the thumb end heal faster, while those closer to the forearm can take 3 months or more. Full strength may take several months of hand therapy.
Can a broken wrist bone heal on its own?
Some undisplaced fractures heal in a cast, but without immobilization, a scaphoid fracture often fails to heal. An untreated fracture can lead to non-union, bone death and wrist arthritis. Get it assessed rather than waiting.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons: Scaphoid fracture of the wrist
- American Society for Surgery of the Hand: Scaphoid fracture
- NICE: Fractures (non-complex) - assessment and management (NG38)
- American College of Radiology: Appropriateness criteria - Acute hand and wrist trauma
- NHS: Broken wrist