Scaphoid Fracture

The scaphoid is one of eight small bones that make up the “carpal bones” of the wrist. It connects two rows of these bones - the proximal row (closer to the forearm) and the distal row (closer to the hand). This connection puts it at extra risk for injury (Figure 1).
Figure 1
The two rows of wrist bones, shown here, are important in understanding a scaphoid fracture.
Figure 2
Location of the scaphoid bone. If you are tender directly over the bone after a scaphoid fracture, you may be asked to wear a splint.
Figure 3
Where a screw or pins would be placed in surgery for a scaphoid fracture

Causes

The scaphoid can be injured when a significant load is placed on the extended wrist, such as a fall onto an outstretched hand.

Signs and Symptoms

Most people with a scaphoid fracture (which is the same as a broken wrist) will have pain and/or swelling along the thumb side of the wrist within days following a fall. Because there is no visible deformity and no difficulty with motion, many people with this injury assume that it is a wrist sprain. Unfortunately, delaying treatment can cause problems. Visit a hand surgeon as soon as possible if you think you might have fractured your wrist.

Diagnosis
A scaphoid fracture is usually diagnosed by an x-ray of the wrist. However, x-rays do not always show scaphoid fractures. A break in the bone that cannot be seen on x-ray yet is called an “occult” fracture. If you are tender directly over the scaphoid bone (which is located in the hollow at the thumb side of the wrist as shown in Figure 2), your healthcare provider might recommend wearing a splint to be safe. If pain persists, a follow-up exam and x-ray in a week or two can be used to diagnose.

Sometimes, a CT scan and/or MRI is used to get better views of the shape and alignment of the scaphoid and assist with the diagnosis or surgery plans.

Treatment

If the scaphoid is broken, the few tiny blood vessels that supply the bone with nutrients can be damaged. Because blood supply is needed to heal a fracture, the scaphoid often takes a long time (a few months) to heal.

If the scaphoid fracture is non-displaced (bone has not moved out of place at the fracture), it usually can be successfully treated with a cast. Although the fracture may heal in as little as six weeks, it may take longer for some patients.

If the fracture is in a certain part of the bone or if the fracture is at all displaced (bone ends have shifted), surgery might be the best option. This might include the insertion of a screw or pins (Figure 3).

Scaphoid Non-Union Fractures

A scaphoid non-union fracture refers to a wrist fracture that is failing to heal. A fracture that is healing more slowly than expected is a “delayed union” fracture. If the scaphoid fracture is not healing, you may or may not continue to have symptoms. It may be a sign that your fracture is not healing if you notice decreased strength, such as inability to do push-ups.

Treatment of a scaphoid non-union fracture depends on many factors, including:

  • Patient age
  • Use of the hand
  • Activity level
  • Symptoms
  • Cigarettes or other tobacco use
  • Other medical and/or wrist conditions
  • Fracture pattern

The goals of treatment are to relieve pain, maximize function and prevent arthritis. Usually, surgery is needed to clean out the fracture site, to potentially place some form of bone graft to help bone healing, and to stabilize the fracture with pins or screws.

Treatment without surgery can include use of a brace, anti-inflammatory medication or a cortisone shot for pain relief. You and your hand surgeon can discuss which treatment is best for you.



This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.
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