A scaphoid fracture is the most common fracture affecting the small bones of the wrist. Although many fractures heal successfully, the scaphoid has a relatively poor blood supply, meaning some fractures can take longer to heal or may fail to unite without appropriate treatment.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including scaphoid fractures, scaphoid non-union, wrist arthritis and complex wrist injuries.
What is a scaphoid fracture?
The scaphoid is the largest of the eight small bones that make up the wrist. It sits on the thumb side of the wrist and forms an important link between the two rows of wrist bones, helping to coordinate normal wrist movement.
The bone is almost completely covered by joint cartilage and has a relatively limited blood supply. For this reason, fractures of the scaphoid have a greater risk of delayed healing or non-union than many other fractures.
Figure 1: X-ray demonstrating a fracture of the scaphoid bone.
How do scaphoid fractures occur?
Most scaphoid fractures occur after falling onto an outstretched hand. The injury is common during sporting activities, cycling accidents and simple slips or falls.
The symptoms are often surprisingly mild. Many people believe they have simply sprained their wrist and do not seek medical attention immediately. This is one reason why scaphoid fractures are sometimes diagnosed several days or even weeks after the injury.
Symptoms of a scaphoid fracture
Typical symptoms include:
- Pain on the thumb side of the wrist
- Pain over the back of the wrist
- Tenderness in the anatomical snuffbox
- Mild swelling
- Reduced wrist movement
- Pain when gripping or lifting objects
- Reduced grip strength
Unlike many fractures, deformity is unusual and bruising may be minimal.
Why are scaphoid fractures important?
Scaphoid fractures require careful assessment because they can be difficult to diagnose and are more prone to healing problems than other wrist fractures.
The main concerns are:
- The fracture may not be visible on the first X-rays.
- The fracture may fail to heal (known as a scaphoid non-union).
- An untreated non-union can eventually lead to wrist arthritis.
Early diagnosis and appropriate treatment significantly reduce these risks. :contentReference[oaicite:2]{index=2}
How is a scaphoid fracture diagnosed?
Diagnosis begins with a careful clinical examination. Tenderness over the scaphoid bone following a fall raises suspicion of a fracture, even if the first X-rays appear normal.
Standard wrist X-rays will usually identify most fractures. If the X-rays are normal but clinical suspicion remains high, the wrist may be immobilised before repeat imaging or advanced imaging is arranged.
A CT scan provides excellent detail of the fracture pattern, whilst MRI scanning can detect fractures that are not visible on plain X-rays and also assess the blood supply to the bone. :contentReference[oaicite:3]{index=3}
Find out what to expect at your outpatient appointment.
Treatment for scaphoid fractures
Treatment depends on where the fracture is located, whether it has moved out of position and the stability of the fracture.
Non-surgical treatment
Most undisplaced scaphoid fractures can be treated successfully using a below-elbow cast.
Immobilisation usually continues for between six and twelve weeks, although fractures involving the proximal pole of the scaphoid often require a longer period because they heal more slowly. :contentReference[oaicite:4]{index=4}
Surgical treatment
Some scaphoid fractures require surgery.
Surgery is generally recommended where the fracture:
- Is displaced
- Is unstable
- Involves the proximal pole
- Is associated with other wrist injuries or ligament damage
The operation usually involves fixing the fracture using a specially designed compression screw. The aim is to stabilise the fracture and encourage reliable healing.
Figure 2: Scaphoid fracture - grey line crossing the scaphoid bone
Recovery after treatment
Healing time varies depending upon the location of the fracture and whether surgery has been required.
During recovery the wrist is protected in a cast or splint before rehabilitation begins. Repeat X-rays or CT scans may be used to confirm that the fracture has healed before unrestricted activities are resumed.
Read more about post-operative care.
Possible complications
Although most scaphoid fractures heal successfully, recognised complications include:
- Delayed union
- Scaphoid non-union
- Loss of blood supply to part of the scaphoid (avascular necrosis)
- Wrist stiffness
- Post-traumatic wrist arthritis
Results of treatment
Most scaphoid fractures heal successfully with appropriate treatment. Early diagnosis remains one of the most important factors in achieving a good outcome and reducing the risk of later complications.
Persistent wrist pain after a fall?
If you have ongoing wrist pain following a fall onto an outstretched hand, particularly if previous X-rays were normal, Mr Robert Farnell can assess whether a scaphoid fracture may have been missed and advise on the most appropriate investigation and treatment.
Scaphoid Fracture FAQs
What is a scaphoid fracture?
A scaphoid fracture is a break in one of the small bones on the thumb side of the wrist.
How do scaphoid fractures happen?
They most commonly occur after falling onto an outstretched hand.
Can a scaphoid fracture be mistaken for a wrist sprain?
Yes. Symptoms are often relatively mild and some fractures are not visible on the first X-rays.
Why are scaphoid fractures slow to heal?
The scaphoid has a relatively poor blood supply, particularly towards the proximal pole, making healing slower than many other fractures.
What happens if a scaphoid fracture is missed?
An untreated fracture may fail to heal and develop into a scaphoid non-union, increasing the risk of wrist arthritis.
Do all scaphoid fractures need surgery?
No. Many undisplaced fractures heal successfully in a cast. Surgery is usually reserved for unstable, displaced or higher-risk fractures.
How long does a scaphoid fracture take to heal?
Healing usually takes between six and twelve weeks, although some fractures take longer depending on their location.
What is a scaphoid non-union?
A scaphoid non-union is a fracture that has failed to heal properly. It may require bone grafting and surgical fixation.
Can a scaphoid fracture cause arthritis?
Yes. If a scaphoid fracture fails to heal, arthritis can gradually develop over time.