Scaphoid non-union occurs when a fracture of the scaphoid bone fails to heal properly. Although most scaphoid fractures unite successfully, some fail to heal despite appropriate treatment. If left untreated, a scaphoid non-union can eventually lead to wrist arthritis, ongoing pain and reduced wrist function.
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 scaphoid non-union?
A scaphoid non-union is a fracture of the scaphoid bone that has failed to heal. The scaphoid has a relatively poor blood supply and is subjected to considerable forces during normal wrist movement, making healing more difficult than many other fractures.
Whilst most scaphoid fractures heal without difficulty, some fail to unite even after treatment. Occasionally the original fracture is not recognised because the initial injury was mistaken for a wrist sprain.
Figure 1: X-ray showing a scaphoid non-union.
Symptoms of scaphoid non-union
Symptoms vary considerably between patients.
Some people have no symptoms at all and the non-union is only discovered after an X-ray following another injury. Others develop persistent wrist pain and stiffness.
- Persistent wrist pain following a scaphoid fracture
- Pain on the thumb side or back of the wrist
- Pain when gripping or lifting
- Pain during push-ups or pushing up from a chair
- Loss of wrist movement
- Reduced grip strength
How is scaphoid non-union diagnosed?
Scaphoid non-union should be suspected in anyone with persistent wrist pain following a known scaphoid fracture. It should also be considered in patients with continuing wrist pain after what was believed to be a wrist sprain.
In many patients, a simple X-ray confirms the diagnosis. Further imaging with a CT scan may be required to assess the fracture in greater detail and MRI scanning may be used to assess the remaining blood supply to the scaphoid bone.
The results of these investigations help determine the most appropriate treatment.
Find out what to expect at your outpatient appointment.
What happens if a scaphoid non-union is left untreated?
Without treatment, most scaphoid non-unions eventually lead to arthritis of the wrist. Although surgery may reduce this risk, it cannot completely eliminate it.
Interestingly, the amount of arthritis seen on an X-ray does not always match the severity of symptoms. Some people have advanced arthritis with relatively little pain, whilst others have significant symptoms with only mild arthritic change.
Treatment for scaphoid non-union
The most appropriate treatment depends on several factors, including whether arthritis has already developed, the age of the injury, the blood supply to the scaphoid and your symptoms.
Non-surgical treatment
Some patients choose not to undergo surgery and manage their symptoms with activity modification, pain relief medication and a wrist splint.
Surgical treatment
If significant arthritis has not yet developed, surgery aims to encourage the fracture to heal.
The most common procedure combines bone grafting with screw fixation. Bone graft may be taken from the pelvis or from the distal radius. In selected patients, a vascularised bone graft from the distal radius may be used, allowing the graft to retain its own blood supply.
Figure 2: Scaphoid non-union treated with bone graft and screw fixation.
If wrist arthritis is already present, surgery is usually directed towards treating the arthritis rather than trying to unite the scaphoid fracture itself.
Recovery after surgery
Recovery depends on the complexity of the non-union, the surgical procedure performed and the rate at which the bone heals.
The wrist will usually be protected in a cast or splint during the early stages of recovery. CT scans are commonly performed to confirm that healing has occurred before unrestricted activities are resumed.
Read more about post-operative care.
Results of surgery
The success of surgery depends on a number of factors, including the location of the non-union, the blood supply to the scaphoid and how long ago the injury occurred.
Overall, successful bone healing is achieved in approximately 50% to 90% of patients. Mr Farnell will discuss your individual chances of healing based on your imaging and clinical findings. :contentReference[oaicite:1]{index=1}
Persistent wrist pain after a scaphoid fracture?
If you continue to experience wrist pain following a scaphoid fracture or have been told your fracture has not healed, Mr Robert Farnell can assess your wrist and advise whether further investigation or surgery may be appropriate.
Scaphoid Non-union FAQs
What is a scaphoid non-union?
A scaphoid non-union is a scaphoid fracture that has failed to heal.
Why do some scaphoid fractures not heal?
The scaphoid has a relatively poor blood supply and is subjected to considerable forces during wrist movement, making healing more difficult than many other fractures.
Can a wrist sprain actually be a scaphoid fracture?
Yes. Some scaphoid fractures are not visible on the first X-rays and may initially be mistaken for a wrist sprain.
What symptoms does a scaphoid non-union cause?
Symptoms commonly include persistent wrist pain, reduced grip strength, pain during lifting, stiffness and discomfort during activities such as push-ups.
How is scaphoid non-union diagnosed?
Diagnosis usually involves X-rays together with CT or MRI scans where appropriate.
Will a scaphoid non-union cause arthritis?
Without treatment, most scaphoid non-unions eventually lead to wrist arthritis.
Can a scaphoid non-union heal without surgery?
Established non-unions rarely heal without surgery, although some patients choose to manage their symptoms non-operatively.
What is a vascularised bone graft?
A vascularised bone graft is living bone transferred together with its blood supply to improve the chance of fracture healing.
How successful is surgery?
Successful healing is achieved in approximately 50% to 90% of patients depending on the individual circumstances. :contentReference[oaicite:2]{index=2}