Scaphoid Fracture (Broken Wrist Bone)

The scaphoid and why it matters

The scaphoid bridges the two rows of wrist bones, making it essential for wrist movement and stability. Its blood supply enters mainly from the end nearest the thumb (distal), so the part nearest the forearm (proximal) depends on blood flowing through the bone. A fracture can cut off this supply, leading to:

• delayed union or nonunion: the bone fails to heal
• avascular necrosis: the proximal fragment dies
• wrist arthritis over years (scaphoid nonunion advanced collapse)

Location affects healing

Symptoms

• pain and swelling on the thumb side of the wrist
• tenderness in the anatomical snuffbox, the hollow at the base of the thumb when it is extended
• pain when gripping, pinching or moving the wrist
• often less dramatic than a typical broken wrist, so people assume it is a sprain

Diagnosis

• examination: snuffbox tenderness, tenderness over the scaphoid tubercle on the palm side, pain with pressing the thumb toward the wrist
• X-rays with scaphoid views: may not show the fracture for up to 2 weeks
• if X-rays are normal but suspicion is high: - immobilize the wrist in a splint or cast - get an MRI (the most accurate test) or CT, or repeat X-rays in 10 to 14 days
• CT to assess displacement and healing

Treating a suspected scaphoid fracture as a fracture until proven otherwise prevents complications.

Treatment

Non-surgical

For stable, non-displaced distal and waist fractures:

• a cast or splint, sometimes including the thumb
• typically 6 to 12 weeks, depending on location
• CT or X-rays to confirm healing before stopping immobilization

Surgery

Recommended for:

• displaced fractures
• proximal pole fractures
• some waist fractures in people who want a faster return to work or sport
• delayed diagnosis or nonunion

A surgeon places a screw through the bone, often through a small incision. Nonunion may need a bone graft. Surgery can shorten time in a cast.

Rehabilitation

Hand therapy restores wrist motion and grip strength after immobilization. Return to contact sports is usually allowed once healing is confirmed, sometimes with a protective splint.

Complications

• nonunion
• avascular necrosis
• malunion (healing in a poor position)
• wrist arthritis
• stiffness and reduced grip

Early diagnosis and adequate immobilization greatly reduce these risks.

Prevention

• wrist guards for snowboarding, skateboarding and rollerblading
• fall prevention and bone health in older adults

Frequently asked questions

What are the symptoms of a scaphoid fracture?

Typical symptoms are pain and swelling on the thumb side of the wrist after a fall on an outstretched hand, tenderness in the snuffbox at the base of the thumb, and pain when gripping or pinching. It often feels like a sprain.

Why might a scaphoid fracture not show on an X-ray?

Scaphoid fractures can be very fine and may not be visible on X-rays for up to 2 weeks. That is why a suspected fracture is immobilized and followed up with repeat X-rays, MRI or CT.

How long does a scaphoid fracture take to heal?

Fractures near the thumb end heal in about 6 weeks. Waist fractures often take 8 to 12 weeks. Proximal fractures heal more slowly and often need surgery. Healing is confirmed with imaging before the cast is removed.

What happens if a scaphoid fracture is not treated?

It may not heal (nonunion) or the bone may lose blood supply (avascular necrosis), leading to chronic wrist pain, weakness and early arthritis. These problems often need surgery with bone grafting.

Do all scaphoid fractures need surgery?

No. Most non-displaced fractures heal in a cast. Surgery is advised for displaced fractures, those near the forearm end of the bone, nonunions, and sometimes to allow faster return to work or sport.