What are Scaphoid fractures?
The scaphoid is one of the eight small carpal bones of the wrist and is located on the thumb (radial) side, just above the radius. It plays a crucial role in wrist stability and movement by acting as a mechanical link between the two rows of carpal bones. This position makes it particularly important for coordinating wrist motion and load transmission during activities such as gripping and weight-bearing. Scaphoid fractures are the most common type of carpal bone fracture and occur most frequently in young, active individuals. Despite sometimes appearing minor, these fractures are clinically significant because the scaphoid has a unique blood supply that can be easily disrupted, increasing the risk of delayed healing or non-union.
Causes
Scaphoid fractures most commonly occur as a result of a fall onto an outstretched hand, with the wrist extended and slightly deviated toward the thumb side. This mechanism places significant force through the scaphoid, making it vulnerable to injury. These fractures are frequently seen in sports, cycling accidents, and falls from height. High-energy trauma, such as motor vehicle accidents, may also result in more complex scaphoid injuries, sometimes in combination with other wrist fractures or ligament damage.
Symptoms
Symptoms of a scaphoid fracture can sometimes be subtle, which may lead to delayed presentation or misdiagnosis. Common symptoms include:
- Pain on the thumb side of the wrist, particularly with movement or gripping
- Tenderness in the anatomical snuffbox (a small depression at the base of the thumb), which is a key clinical sign
- Swelling around the wrist, although this may be mild
- Reduced range of motion and discomfort when attempting to move the wrist or thumb
- Decreased grip strength
In some cases, patients may initially dismiss the injury as a simple sprain, especially if pain is not severe. However, untreated scaphoid fractures can lead to significant long-term complications.
Diagnosis
Accurate diagnosis of a scaphoid fracture is essential to ensure appropriate management and to minimise the risk of complications. Diagnosis is based on a combination of clinical assessment and imaging.
During examination, your surgeon will check for tenderness in specific areas, particularly the anatomical snuffbox and over the scaphoid tubercle. Pain with certain wrist movements or compression tests may further raise suspicion.
Because some fractures are not immediately visible on initial imaging, a high index of suspicion is important. If clinical findings suggest a fracture, treatment may be initiated even if early imaging appears normal.
Imaging
Imaging plays a critical role in confirming the diagnosis and guiding treatment. X-rays are the first-line investigation and typically include specialised scaphoid views, although fractures may not be visible in the early stages, particularly if they are non-displaced. CT scans provide detailed images of bone and are useful for assessing fracture location, displacement, and healing progress, while MRI scans are highly sensitive and can detect occult (hidden) fractures soon after injury, as well as assess bone marrow oedema and associated soft tissue injuries. In cases where initial X-rays are negative but clinical suspicion remains high, repeat imaging or advanced modalities such as MRI are often recommended.
Treatment
Conservative (Non-operative)
Treatment of Scaphoid fracture depends on the location of the fracture, the degree of displacement, and the risk of impaired healing. Non-displaced or minimally displaced fractures are often managed conservatively with immobilisation, typically involving the application of a cast or splint and immobilisation for several weeks to months depending on fracture healing. Regular follow-up with imaging is required to ensure proper healing. Due to the scaphoid’s limited blood supply—particularly to its proximal (nearer the forearm) portion—healing can be slow, so close monitoring is essential.
Surgical treatment
Surgical treatment may be recommended for displaced fractures, fractures involving the proximal pole, or cases at high risk of non-union or avascular necrosis (loss of blood supply to the bone). It may also be considered for patients who require a quicker return to activity.
Surgical options typically involve internal fixation of the fracture using screws or, less commonly, wires. The goal is to stabilise the bone fragments, promote healing, and restore normal wrist anatomy. In some cases, bone grafting may be required, particularly if there is delayed healing or non-union.
Recovery
Postoperative recovery usually includes a period of immobilisation followed by rehabilitation to restore wrist strength and mobility. Outcomes are generally good when fractures are treated appropriately, but delayed or missed diagnosis can lead to complications such as chronic pain, reduced function, or wrist arthritis.
When can I return to daily activities
- 0–2 weeks: Wrist is usually immobilised in a splint or cast. Focus is on pain control and finger movement. Most daily tasks require assistance.
- 2–6 weeks: Gradual return to light self-care activities such as eating, dressing, and grooming, while the wrist remains protected.
- 6–8 weeks: Increased independence in basic daily activities as pain improves, though lifting and wrist loading are still avoided.
- 8–12 weeks: Many patients can return to light daily activities and desk-based work with improving wrist motion.
- 3–4 months: Most routine daily activities can usually be resumed with near-normal use of the hand.
- 4–6 months: Return to heavier tasks such as lifting, manual work, and repetitive wrist use as strength continues to improve.
- 6+ months: Full unrestricted use of the wrist is typically possible once complete healing is confirmed.
When can I return to leisure activities?
0–6 weeks: Limited to non–wrist-based activities such as walking, reading, and passive hobbies.
6–12 weeks: Return to low-impact leisure activities that do not stress the wrist (e.g., stationary cycling, light social activities).
3–4 months: Many patients can resume recreational activities such as gym lower-body workouts, gentle swimming, or modified hobbies.
4–6 months: Gradual return to more demanding activities such as swimming, golf, or light racquet sports.
6–9+ months: Return to high-impact or high-load sports and heavy recreational use of the wrist once strength, motion, and healing are fully restored.
Recovery after open reduction and internal fixation should always be guided by the treating surgeon and physiotherapist, as healing can be slower in this bone compared with others in the wrist.