What Is A Scaphoid Fracture?

  • Sophie Olah Master of Science - MS, Science Communication, Imperial College London
  • Richa Lal MBBS, PG Anaesthesia, University of Mumbai, India

Get our weekly health related email

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers located in countries outside of the EU. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative

What is a scaphoid fracture?

The scaphoid bone is a bone at the base of your thumb forming part of your wrist.  A scaphoid fracture is when there is a break in this bone and most commonly occurs when falling onto an outstretched hand, with your palm facing the ground and your wrist bent.

Causes of scaphoid fracture

Falls are a common cause of the fracture followed by trauma such as in a car accident. Stress fractures of the scaphoid bone may also occur in certain groups, like gymnasts or tennis players.1,8

Common symptoms

Usually following a known trauma, the symptoms can include:

  • Pain around  the thumb
  • Bruising or swelling      
  • Restricted, painful movement 
  • A reduction in grip strength

Anatomy of the scaphoid bone

The forearm connects the elbow with the wrist and is made of two bones, the radius and ulna, with the radius being on the thumb side.

The scaphoid is one of eight small bones in the wrist called carpal bones. These are arranged in two rows: the proximal row closest to the forearm and the distal row closest to the fingers. The scaphoid bone connects the two rows together and is the size and shape of a cashew nut.1

Types of scaphoid fracture

Scaphoid fractures are classified according to the location of the fracture of the bone:2

  • Proximal pole – This is the third of the bone closest to the forearm.  Approximately 15% of breaks occur here
  • Waist –The central third of the bone, most fractures occur here with it making up roughly 65%
  • Distal pole –The third of the bone closest to the thumb, where approximately 10% of fractures happen

Diagnosis

A medical professional will perform a clinical examination and take a clinical history.

There is an area of the hand, at the base of the thumb called the anatomical snuffbox that can become tender with a scaphoid fracture.1

In addition to the clinical examination, diagnostic imaging may be required.

Diagnostic imaging

Radiographs (X-rays) can help determine if there is a scaphoid fracture, although in some cases they do not show up straight away. Magnetic resonance imaging (MRI) or computed tomography (CT) scans are different types of imaging, providing additional information to an X-ray, enabling surgeons to decide which treatment is best and to offer a more accurate prognosis, reducing the chances of complications.3,4 

Treatment

Pain relief, including anti-inflammatory medication, can be taken under the direction of medical professionals.5 

The treatment options  depend on:

  • Location of the fracture
  • Whether the fracture is “open” (i.e. pierced the skin)
  • If the bone fragments are displaced (i.e. not in their normal alignment)
  • When the injury occurred

Conservative treatment

If the fracture is non-displaced, conservative management may be offered.  Non-surgical options can involve wearing a cast or splint for several weeks.  The latest evidence suggests there is no significant benefit for either method of immobilisation.2,6  

Surgery

If the fracture is displaced surgery may be advised. The surgeon will decide the best method of repairing the fracture but could involve pins, screws and plates. The aim of having surgery is to return to normal movement, potentially allowing an earlier return to work and exercise.  However, complications can occur such as infection, failure of repair and scar-related problems.3

Recovery

Whether the fracture is treated surgically or not, you may be advised by a medical professional to wear a cast or splint for multiple weeks after treatment.  Immobilisation should be continued until advised by your medical professional.  It is advised to follow the guidance of a physiotherapist to discuss which exercises and activities can be performed safely. 

It takes on average between six and twelve weeks to return to activity after treatment. This is provided there are no complications and the advice from your medical professional and physiotherapist has been followed. 

The importance of being seen early

To avoid complications and prolonged healing, it is best to be seen by a healthcare professional promptly.7,8  

Complications

Delayed union or non-union

Delayed union is when the fracture has not healed completely after four months of being immobilised.  Non-union happens when the fracture has not healed at all, and the bone fragments are still separated.4

Factors affecting the likelihood of this happening include where the fracture is located, how soon medical advice was sought, and how diligently the injury has been immobilised.Blood supply to the scaphoid is relatively poor, and so non-union is more common than fractures of other bones.

If the fracture does not heal, you may need to immobilise for a longer period or surgery may be indicated.

Avascular necrosis

Avascular necrosis refers to a condition in which there is a disrupted or limited blood supply to the bone. The blood carries oxygen and nutrients to the cells and bone, without this, they die off.  This affects the ability of the bone to heal.

Arthritis

Arthritis may develop in the wrist following a fracture complication caused by non-union or avascular necrosis.  This is when the cartilage in the joint is damaged, leading to symptoms of arthritis such as pain, stiffness and restriction in movement.

FAQs

What should I do if I am given a cast or splint?

Your healthcare professional should inform you how best to look after your injury if it requires a cast.  This could include:

  • Keeping it on at all times
  • Keeping your fingers moving
  • Elevating your hand soon after the injury
  • Not sticking anything down the cast or getting it wet

When can I return to playing sports?

Your medical professional will advise about when this is feasible.

Are any groups more prone to a scaphoid fracture?

They are more commonly seen in persons assigned male at birth and rarely seen in children or the elderly.5

Summary

Scaphoid fractures occur in a small bone in the wrist near the thumb.  They are classified by location and usually occur after a fall or trauma onto an outstretched hand.

Treatment options include casts, splints and surgical intervention.  It is important to be seen by a medical professional early as this can affect outcomes.

There can be complications following initial treatment, and this may warrant further procedures or additional treatments.

References

  1. Clementson M, Björkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev [Internet]. 2020 Feb 26 [cited 2023 Nov 9];5(2):96–103. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047900/
  2. Hayat Z, Varacallo M. Scaphoid wrist fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK536907/
  3. Dias JJ, Ring D, Grewal R, Clementson M, Buijze GA, Ho P-C. Acute scaphoid fractures: making decisions for treating a troublesome bone. J Hand Surg Eur Vol [Internet]. 2022 [cited 2024 Jun 4]; 47(1):73–9. Available from: http://journals.sagepub.com/doi/10.1177/17531934211053441.
  4. Basso MA, Smeraglia F, Ocampos-Hernandez M, Balato G, Bernasconi A, Corella-Montoya F. Scaphoid fracture non-union: a systematic review of the arthroscopic management. Acta Biomed [Internet]. 2023 [cited 2024 Jun 4]; 94(5):e2023194. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644916/.
  5. Cohen A, Claessen T, Berg C van den, Siebelt M, Hagenaars T, Kraan GA, et al. Morphological risk factors for scaphoid fracture: a case–control study. Eur J Trauma Emerg Surg [Internet]. 2023 [cited 2024 Jun 4]; 49(1):133–41. Available from: https://doi.org/10.1007/s00068-022-02101-y.
  6. Andersson JK, Gustafson P, Kopylov P. Misdiagnosed and maltreated scaphoid fractures – costly both for society and patients: A review of filed claims to the Swedish National Patient Insurance Company 2011–2018. EFORT Open Reviews [Internet]. 2022 [cited 2024 Jun 4]; 7(2):129–36. Available from: https://eor.bioscientifica.com/view/journals/eor/7/2/EOR-21-0108.xml.
  7. Dutta A, Crate G, Bakti N, Nicholl J. Management of scaphoid fractures with CT scanning and virtual fracture clinic pathway reduces need for face-to-face clinic appointments. annals [Internet]. 2021 [cited 2024 Jun 4]; 103(9):678–82. Available from: https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2021.0022.
  8. Nakamoto JC, Saito M, Medina G, Schor B. Scaphoid Stress Fracture in High-Level Gymnast: A Case Report. Case Reports in Orthopedics [Internet]. 2011 [cited 2024 Jun 4]; 2011:1–3. Available from: http://www.hindawi.com/journals/crior/2011/492407/.

Get our weekly health related email

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers located in countries outside of the EU. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Christopher Burke

MBBS, GKT School of Medical Education, King's College London

Chris is a tutor who holds a degree in medicine from King's College London. He enjoys writing informative yet easy to read articles relating to health and disease with the aim of educating people about various conditions. During his time at university, he continually worked on his writing and presentation skills, and was awarded the highest mark of his cohort for a literature review. He has helped many students from primary school to university level achieve their goals and is particularly interested in immunology research.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818