Scaphoid Fractures

Wrist bones showing scaphoid location
Figure 1. The two rows of wrist bones and the scaphoid bone.

The scaphoid is one of eight small carpal bones in the wrist. It connects the proximal row of wrist bones closer to the forearm with the distal row closer to the hand. This position puts the scaphoid at extra risk for injury.

Causes

A scaphoid fracture usually occurs after a fall onto an outstretched hand.

Signs and Symptoms

Pain, with or without swelling or bruising on the thumb side of the wrist, may appear within days after a fall. Because there may be no visible deformity and motion may still be possible, many people assume the injury is only a wrist sprain. Delayed treatment can cause problems, so a hand surgeon should evaluate a possible wrist fracture.

Thumb-side wrist hollow snuffbox location
Figure 2. Location of the scaphoid bone at the thumb-side wrist hollow.

Diagnosis

Scaphoid fractures are often diagnosed with wrist x-rays. However, an x-ray may not always show the fracture right away. A fracture that cannot yet be seen on x-ray is called an occult fracture.

If there is tenderness directly over the scaphoid bone in the hollow on the thumb side of the wrist, a splint may be recommended to be safe. If pain continues, a follow-up exam and x-ray in one to two weeks may help confirm the diagnosis. CT scan, bone scan, or MRI may also be used.

Scaphoid fracture fixation with screw or pins
Figure 3. Example of where a screw or pins may be placed in surgery.

Treatment

If the fracture is non-displaced, meaning the bone has not moved out of place, it can often be treated successfully with a cast. Although healing may occur in as little as six weeks, it can take longer for some patients.

If the fracture is in certain parts of the bone or if the bone ends have shifted, surgery may be the best option. Surgery may involve placing a screw or pins to stabilize the fracture.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.