Scaphoid Fracture

Overview

The scaphoid is one of the small bones of the wrist, located on the thumb side, near the base of the thumb. A scaphoid fracture is a break in this bone, and it is the most common type of wrist (carpal) bone fracture. It usually happens when a person falls and lands on an outstretched hand, forcing the wrist to bend back sharply.

Scaphoid fractures deserve special attention because the bone has a limited blood supply, particularly at one end. This means some fractures heal slowly or, if missed or untreated, may fail to heal properly, leading to long-term wrist problems. Because the break is not always obvious on early X-rays, any wrist injury with pain on the thumb side should be evaluated carefully.

Symptoms

Symptoms can be surprisingly mild, which is one reason these fractures are missed:

• Pain and tenderness on the thumb side of the wrist, especially in the small hollow known as the anatomical snuffbox
• Swelling around the wrist near the base of the thumb
• Pain with gripping, pinching, or moving the wrist
• Reduced grip strength

There may be little or no bruising or obvious deformity, so the injury can be mistaken for a simple sprain. Persistent wrist pain after a fall should not be ignored.

Causes

Scaphoid fractures are almost always caused by trauma to the wrist:

• Fall onto an outstretched hand: The most common cause, where the impact forces the wrist into extension.
• Sports injuries: Common in activities like cycling, skating, football, and basketball.
• Direct impact or motor vehicle crashes: A forceful blow to the wrist or hand.

Risk Factors

• Participation in contact or high-speed sports
• Activities with a risk of falling, such as cycling and skating
• Younger, active adults, in whom these fractures are common
• Conditions that weaken bone, such as osteoporosis

Diagnosis

Because scaphoid fractures can be hard to see at first, diagnosis may take more than one visit:

• Examination: Checking for tenderness in the anatomical snuffbox and pain with thumb and wrist movement.
• X-rays: Often the first test, though a fracture may not appear immediately.
• Repeat imaging or advanced scans: If a fracture is suspected but not seen, the wrist may be splinted and re-X-rayed later, or an MRI or CT scan may be done to confirm.

Treatment

Treatment depends on the location of the fracture and how well the bone fragments are aligned.

• Casting: Many fractures that are not displaced heal with a cast or splint, sometimes for several weeks to a few months because of the bone's slow healing.
• Surgery: Displaced fractures, fractures at the end with poor blood supply, or those that fail to heal may need surgery with a small screw or pins to hold the bone.
• Monitoring healing: Follow-up imaging confirms the bone is mending.

Because of the risk of poor healing, following treatment closely and keeping follow-up appointments is important.

Prevention

• Wear wrist guards in activities like skating, cycling, and snowboarding
• Use proper technique and protective gear in sports
• Reduce fall hazards at home and work
• Maintain bone health, especially if you have osteoporosis

When to See a Doctor

See a doctor after any wrist injury that causes pain on the thumb side, even if it seems minor or you can still move the wrist, because scaphoid fractures are easily mistaken for sprains. Prompt evaluation is important, as early treatment improves healing. Seek urgent care if the wrist is visibly deformed, severely swollen, numb, or if the skin is broken over the injury.

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (OrthoInfo). Scaphoid Fracture of the Wrist.
2. Mayo Clinic. Broken wrist.
3. MedlinePlus, U.S. National Library of Medicine. Wrist injuries and disorders.
4. American Society for Surgery of the Hand. Scaphoid Fracture.