Scaphoid Fracture: A Comprehensive Guide
Overview
A scaphoid fracture is a break in the scaphoid bone, one of the small bones in the wrist. Located on the thumb side of the wrist, the scaphoid is essential in connecting the two rows of carpal bones and plays a key role in wrist stability and movement.
Anatomy of the Scaphoid Bone and Its Importance in Wrist Function
The scaphoid bone has a unique position and shape, bridging the forearm bones (radius and ulna) to the hand. Its distinctive curved, boat-like shape allows it to articulate with multiple wrist bones, supporting the smooth motion of the wrist and absorbing impact from forces transmitted through the hand. Due to its limited blood supply, particularly at the proximal end, the scaphoid is vulnerable to delayed healing and non-union when fractured, especially if not diagnosed early or managed effectively.
Types of Scaphoid Fractures
Scaphoid fractures are classified based on the location of the fracture along the bone, and this location can influence treatment and healing time.
- Proximal Pole Fractures: This refers to fractures at the end of the scaphoid bone closest to the forearm. These fractures are more challenging to heal due to poor blood supply in this area, which can prolong healing time and increase the risk of complications like avascular necrosis (bone death due to lack of blood flow).
- Waist Fractures: These are the most common type of fractures, occurring in the middle of the scaphoid bone. If treated properly, waist fractures can heal reasonably well, but inadequate blood flow remains a concern, so healing may be slower than in other bones.
- Distal Pole Fractures: These fractures are located at the end of the scaphoid bone closest to the thumb. Distal pole fractures tend to heal faster than proximal fractures because of better blood supply.
How Common Are Scaphoid Fractures?
Scaphoid fractures are among the most common wrist fractures. They typically occur from falls onto an outstretched hand, where the impact travels up the wrist and causes the scaphoid to fracture. These fractures are often seen in younger, active individuals involved in sports and motor vehicle accidents.
Because scaphoid fractures may not always be immediately visible on X-rays, early diagnosis can be challenging, leading to potential complications if not identified promptly.
If you have concerns about a scaphoid fracture, it is important to get specialist orthopaedic advice. Access Ortho offers urgent appointments for fractures and other musculoskeletal injuries and specialises in orthopaedic injuries.
Symptoms and Causes
Causes of Scaphoid Fractures
Scaphoid fractures occur most commonly from a fall onto an outstretched hand (FOOSH injury), with the wrist extended and compressed. This type of impact generates force that travels up the arm and focuses on the scaphoid bone, which is positioned in a way that makes it prone to breaking under such stress.
Common Injury Mechanisms
- Falls onto an Outstretched Hand (FOOSH): This is the most common cause, particularly from sports, recreational activities, or accidental falls.
- Direct Trauma to the Wrist: A strong blow or impact on the wrist can also fracture the scaphoid.
- Motor Vehicle Accidents: Rapid deceleration or direct trauma to the wrist, as the body reacts to a collision, can cause scaphoid fractures.

Risk Factors for Scaphoid Fractures
- Age: Young adults (15-30 years) are more prone due to high activity levels and a preference for riskier sports.
- High-impact sports: Athletes in contact sports, skateboarding, cycling, and snowboarding are at increased risk.
- Occupations with Fall Risk: Workers who frequently climb or work at heights are at risk of falls that can injure the scaphoid.
- Previous Wrist Injuries: Prior wrist injuries or fractures can make the scaphoid more vulnerable.
Symptoms of a Scaphoid Fracture
The symptoms can vary depending on the type of fracture and the timing of the injury.
Acute Symptoms
- Pain and Tenderness in the Wrist: This is most pronounced at the base of the thumb and is often described as a deep, aching pain.
- Swelling and Bruising: Localised around the “snuffbox” area (the small depression at the base of the thumb).
- Reduced Range of Motion: Pain with wrist or thumb movement, especially when trying to grip or squeeze objects.
Chronic Symptoms in Untreated Fractures
- Persistent Wrist Pain: Unresolved or increasing pain in the wrist, often accompanied by tenderness.
- Weakness in Grip Strength: Difficulty performing tasks that require grip or lifting.
- Reduced Range of Motion: Restricted wrist and thumb movement, often painful.
- Wrist Instability: Chronic fractures can lead to misalignment in wrist bones, causing instability.
Complications of Scaphoid Fractures
Due to its delicate blood supply, scaphoid fractures are prone to complications, especially if not treated promptly.
Non-Union
Non-union is a common complication where the fractured parts of the bone fail to heal properly, remaining separated. This may lead to chronic pain and instability in the wrist and often requires surgical intervention to address the issue.
Avascular Necrosis
Avascular necrosis (AVN) is a severe complication, especially for proximal fractures. It occurs when the blood supply to the scaphoid is compromised, leading to death of the bone tissue. AVN can cause chronic pain and eventual collapse of the bone, affecting wrist movement.
Scaphoid Non-union Advanced Collapse (SNAC)
SNAC is a progressive condition that develops if a non-united scaphoid fracture is left untreated. Over time, it leads to misalignment and arthritis in the wrist due to joint degeneration. SNAC is a painful, disabling condition that usually requires surgery, such as bone grafts, partial wrist fusion, or even full wrist fusion, depending on its severity.
Recognising scaphoid fractures and seeking prompt treatment can significantly reduce the risk of these complications. Early intervention, often involving immobilisation or surgery, is essential to ensure proper healing and minimising long-term wrist issues. Access Ortho is a private fracture clinic offering urgent appointments to assess and treat scaphoid fractures and other orthopaedic injuries.
Diagnosis and Tests
How Are Scaphoid Fractures Diagnosed?
Diagnosing scaphoid fractures involves a combination of physical examination and imaging tests. Because initial X-rays sometimes miss small or non-displaced fractures, advanced imaging or follow-up may be necessary to confirm the diagnosis.

Physical Examination for Scaphoid Fractures
During the physical examination, certain areas of the wrist are assessed for tenderness, as this can indicate a scaphoid fracture.
- Anatomic Snuffbox Tenderness: Pressing on the anatomic snuffbox (a small depression at the base of the thumb) is a common initial test. Tenderness in this area is a strong indicator of a scaphoid fracture.
- Scaphoid Tubercle Tenderness: Tenderness at the scaphoid tubercle (on the palm side of the wrist, near the base of the thumb) may also suggest a scaphoid fracture.
These tenderness tests are generally performed together. While they are helpful for an initial assessment, they are not conclusive, and imaging is often required for a definitive diagnosis.
Tests Used to Diagnose Scaphoid Fractures
X-Rays: Initial Imaging and Limitations
- Initial Test: Standard wrist X-rays are typically the first imaging modality used for scaphoid fractures.
- Limitations: Small, non-displaced, or occult fractures may not be visible on initial X-rays. This limitation can lead to missed diagnoses if additional imaging is not performed when symptoms persist.
CT Scans: For Detailed Fracture Assessment
- Role: A CT (computed tomography) scan is often used if a fracture is visible but requires further evaluation. CT scans provide detailed images and help assess the fracture’s exact location, alignment, and severity.
- Usefulness: CT scans are particularly valuable in surgical planning, as they can clarify complex fractures and assess whether bone fragments are displaced.
MRI: For Suspected Occult Fractures
- Role: MRI (magnetic resonance imaging) is ideal for identifying fractures not visible on X-rays (occult fractures). It can also detect bone bruises, soft tissue injuries, and early signs of avascular necrosis.
- Usefulness: MRI is highly sensitive and can identify scaphoid fractures soon after injury, making it a crucial test when early X-rays are inconclusive.
Bone Scans: Alternative for Occult Fractures
- Role: Bone scans can be an alternative to MRI for detecting occult fractures. Bone scans detect increased bone activity associated with fracture healing, showing up as a “hot spot.”
- Usefulness: While not as commonly used as MRI, bone scans are sometimes preferred if MRI is unavailable or contraindicated.
Specific Considerations in Diagnosing Scaphoid Fractures
Delayed Presentation Challenges
If the injury is not immediately treated or diagnosed, patients may present weeks or even months later with chronic symptoms. In such instances, imaging like MRI or CT scans is essential to assess the fracture’s state, as healing issues or complications like non-union may already be developing.
Occult Fractures and Follow-Up Imaging
Occult fractures are fractures not visible on initial imaging. If scaphoid fracture symptoms are present but X-rays appear normal, providers may recommend:
- Repeat Imaging: Follow-up X-rays after a week or two, as small fractures may become visible as healing progresses.
- Advanced Imaging: MRI or bone scan if symptoms persist, allowing for early intervention even in the absence of visible fracture lines on X-rays.
In conclusion, diagnosing a scaphoid fracture requires careful clinical assessment and the appropriate imaging strategy, especially given the risk of complications and the frequency of occult fractures. Early diagnosis is essential to avoid long-term issues such as non-union and avascular necrosis. It is important to seek orthopaedic advice for scaphoid fractures, especially if symptoms persist. Access Ortho offers urgent orthopaedic appointments.
Management and Treatment
How Are Scaphoid Fractures Treated?
Treatment of scaphoid fractures depends on the fracture’s location, severity, and displacement. The goal is to achieve bone healing, restore wrist function, and prevent complications.
Conservative Treatment Options
Cast immobilisation is the preferred treatment option for non-displaced or minimally displaced fractures. By immobilising the wrist, conservative treatment aims to allow the bone to heal without surgery. Access Ortho can fit casts for scaphoid fractures or refer to hand therapy if a custom cast is required.
Cast Immobilisation for Non-Displaced Fractures
- Indication: Non-displaced fractures, especially in the scaphoid’s distal or middle part (waist), are often suitable for conservative management.
- Type of Casting: Traditionally, a thumb spica cast (a cast that includes the thumb) is used to immobilise the wrist and prevent any motion that could disrupt healing.
Duration and Type of Casting
- Duration: Casting duration can range from 6 to 12 weeks, depending on the location and healing progress. Proximal fractures (closer to the forearm) may require a longer immobilisation period due to poorer blood supply.
- Short or Long Casts: Initially, a long arm cast may be used to stabilise the wrist, followed by a short arm cast as healing progresses.

Surgical Interventions for Scaphoid Fractures
For displaced fractures or fractures that fail to heal with casting, surgery is often recommended to ensure proper alignment and healing. Surgery is also indicated in cases of non-union or avascular necrosis.
Indications for Surgery
- Displaced Fractures: When there’s a visible gap or misalignment between the fracture fragments.
- Proximal Pole Fractures: Due to limited blood supply, these fractures are more likely to need surgical intervention.
- Non-Union: If the bone fails to heal after a period of conservative treatment.
- Avascular Necrosis: Early surgery can sometimes help improve blood supply to the bone.
Types of Surgical Procedures
- Percutaneous Screw Fixation
Procedure: A small incision is made, and a screw is inserted percutaneously (through the skin) to stabilise the fracture.
Benefits: This method is minimally invasive, resulting in shorter recovery time and less post-operative pain.
Indication: Suitable for non-displaced or minimally displaced fractures where screw fixation can stabilise the bone without needing to open the joint.
- Open Reduction and Internal Fixation (ORIF)
Procedure: In cases where the fracture is displaced, an open approach allows the surgeon to realign the bone fragments. Screws or pins are then used to fix the bone in place.
Benefits: Ensures accurate alignment of fracture fragments, especially in complex or displaced fractures.
Indication: Displaced fractures or fractures with significant instability.
- Bone Grafting for Non-Union
Procedure: Bone grafts from another part of the patient’s body (often the iliac crest of the pelvis) or a donor are placed around the fracture site to stimulate healing.
Indication: Used for fractures with non-union or when there is evidence of avascular necrosis.
Purpose: Bone grafts provide structural support and stimulate healing by improving blood supply to the area.
Rehabilitation and Physiotherapy for Scaphoid Fractures
After immobilisation or surgery, rehabilitation is essential to restore wrist function, flexibility, and strength. Recovery time varies, but physiotherapy can expedite the return to normal activities. Rehabilitation exercises must always be done under the guidance of your medical team.
Wrist Exercises
- Range of Motion Exercises: Gentle wrist movements help improve flexibility and prevent stiffness. Exercises include wrist flexion, extension, and rotation, typically started under the guidance of a physiotherapist.
- Progressive Loading: As healing progresses, gradually loading the wrist helps rebuild strength and endurance in the muscles and tendons around the joint.
Grip Strength Rehabilitation
- Grip Strength Exercises: Performing grip and release exercises using hand grippers, therapy putty, or soft foam balls improves overall wrist and hand function.
- Progressive Resistance: Once the fracture has healed sufficiently, progressive resistance exercises help restore full grip strength.
Treatment for scaphoid fractures aims for a balance between achieving healing and preventing stiffness. Early intervention and proper rehabilitation can greatly improve outcomes, restoring full wrist function and minimising the risk of complications like non-union and avascular necrosis. An orthopaedic opinion is required to ensure you receive the best care. Access Ortho offers specialist orthopaedic care and rapid appointments.
Prevention
Preventing scaphoid fractures primarily involves strategies to reduce the impact on the wrist during falls or high-risk activities.
Proper Fall Techniques
Learning how to fall safely can reduce the risk of scaphoid fractures. In a fall, try to avoid extending the arm to catch yourself directly, which can lead to wrist fractures. Instead, aim to roll with the fall or distribute the impact across your body, protecting the wrists from sudden forces.
Wrist Guards and Protective Equipment in Sports
Wearing wrist guards or protective gear during high-risk activities, such as skateboarding, snowboarding, and rollerblading, provides additional support and helps absorb impact forces. These protective measures can significantly lower the likelihood of wrist injuries by stabilising the wrist during falls.
By practising safe techniques and using appropriate protective gear, you can reduce your risk of scaphoid fractures.
Outlook / Prognosis
If you have a scaphoid fracture, you can expect a period of immobilisation, potential surgery, and rehabilitation. The recovery process and long-term outcomes will depend on the location and severity of the fracture and the treatment method used.
What is the Recovery Time from a Scaphoid Fracture?
Recovery time varies depending on the fracture location, treatment type, and the individual’s overall health. For most fractures, healing time generally ranges from 6 to 12 weeks, although it can extend longer in complex cases or when complications arise.
Healing Times for Different Fracture Locations
- Distal Pole Fractures: These fractures have a good blood supply and may heal in 6–8 weeks with immobilisation.
- Waist (Middle) Fractures: The most common scaphoid fracture type, these generally heal within 8–12 weeks but may require a longer period if treatment is delayed.
- Proximal Pole Fractures: Due to poor blood supply, these fractures have the slowest healing time and often require surgical intervention. Recovery can take up to 6 months.
Long-Term Outcomes and Potential Complications
Most scaphoid fractures heal without complications if diagnosed and treated promptly. However, potential complications include:
- Non-Union: If the bone does not heal properly, persistent pain and reduced wrist function can result.
- Avascular Necrosis: Limited blood flow, especially in proximal fractures, can lead to bone death, resulting in chronic pain and instability.
- Arthritis: Untreated or improperly healed fractures can lead to joint degeneration, known as Scaphoid Non-union Advanced Collapse (SNAC), which can severely limit wrist function over time.
Return to Work and Sports Considerations
Return to daily activities, work, and sports depends on the healing process and the type of treatment. After immobilisation or surgery, a period of rehabilitation is necessary to regain strength and flexibility.
- Light Activities: Most people can return to light daily activities, like typing, within weeks after immobilisation.
- Sports and High-Demand Tasks: Athletes and those with physically demanding jobs may require several months and successful completion of rehabilitation before safely returning.
With proper treatment and rehabilitation, most people with scaphoid fractures can expect to return to regular activities. However, some may experience occasional stiffness or mild pain, especially with intensive wrist use. Access Ortho offers Urgent Care for scaphoid fractures. In addition to a rapid assessment and early treatment, Access Ortho offers follow-up care with an Orthopaedic surgeon in the clinic.
When to Seek Medical Attention
If you suspect a scaphoid fracture, you should seek prompt evaluation at a fracture clinic such as Access Ortho or by a healthcare provider, especially if you have any of the following red flags that warrant immediate medical attention:
Red Flags: When Immediate Medical Attention is Necessary
- Severe Wrist Pain After Injury: Persistent or severe pain in the wrist, particularly at the base of the thumb, is a key indicator of a potential scaphoid fracture.
- Swelling and Bruising: Visible swelling, bruising, or tenderness over the anatomic snuffbox (small depression at the base of the thumb) can signal a fracture.
- Limited Range of Motion: Inability to move the wrist or thumb comfortably, especially if movement worsens the pain.
- Loss of Grip Strength: Difficulty holding objects or weakness in the hand following a fall or direct trauma.
- Previous Wrist Injury: If you’ve had a recent wrist injury that hasn’t improved with time or worsens with activity.
Scaphoid fractures may not always be visible on initial X-rays, so follow-up imaging or specialist care may be necessary. Delaying treatment can lead to complications, including non-union and avascular necrosis, so it’s essential to get assessed early if any symptoms persist. Access Ortho treats many scaphoid injuries and is aware of the complications that may arise. Contact Access Ortho if you have concerns regarding your hand injury and need rapid, affordable orthopaedic care.

What is a Fracture Clinic?
Role of fracture clinics in scaphoid fracture management
Fracture clinics like Access Ortho play an important role in the timely and specialised management of scaphoid fractures. By offering faster access to orthopaedic specialists and tailored treatment options, these clinics help optimise outcomes for patients with scaphoid fractures, which require prompt and precise care due to the bone’s vulnerability to complications.
Key Benefits of Fracture Clinics for Scaphoid Fracture Management
- Immediate Access to Specialist Care: Clinics like Access Ortho provide direct, often same-day access to orthopaedic specialists experienced in managing complex fractures, including scaphoid injuries. This reduces waiting times, which is critical for scaphoid fractures that need early diagnosis to prevent complications. All staff at Access Ortho are highly trained in orthopaedic care.
- Advanced Imaging Options: Access Ortho can refer for imaging (e.g., CT scans and MRI) available nearby. Advanced imaging is crucial for scaphoid fractures, as these fractures can be subtle and sometimes missed on standard X-rays. Quick access to imaging allows for accurate diagnosis and treatment planning.
- Individualised Treatment Plans: Fracture clinics such as Access Ortho provide personalised treatment options, including conservative and surgical approaches tailored to the specific fracture type. Specialists at these clinics can make quick decisions about whether immobilisation, percutaneous fixation, or other surgical interventions are necessary, potentially expediting the healing process.
- Follow-Up and Monitoring: Access Ortho differs from emergency departments and Urgent care clinics in that it offers follow-up visits with orthopaedic surgeons. This allows for close monitoring of healing progress and immediate adjustments to treatment if needed. This can be especially beneficial for patients with high-risk fractures or those requiring intensive post-surgical care.
Summary
Fracture clinics, such as Access Ortho, can provide expedited, high-quality care for scaphoid fractures. This includes faster diagnosis, access to advanced imaging, personalised treatment plans, and comprehensive follow-up. For patients who need timely intervention, such as those with high physical demands or urgent return-to-work requirements, these clinics are an excellent option to ensure optimal recovery and reduce the risk of long-term wrist complications.
- What to expect during your fracture clinic visit
During a fracture clinic visit, you can expect a thorough evaluation of your injury, personalised treatment planning, and detailed guidance on recovery. Here’s a breakdown of what typically happens:
1. Initial Assessment
- Patient History: Your clinician will ask about how the injury occurred, your pain level, and any previous wrist injuries or medical conditions that may affect healing.
- Physical Examination: The clinician will check for tenderness, swelling, range of motion, and signs specific to scaphoid fractures, such as tenderness in the anatomic snuffbox and over the scaphoid tubercle.
2. Imaging and Diagnosis
- X-Rays: If not already performed, standard X-rays may be arranged to assess for any visible fracture or displacement.
- Advanced imaging (if needed): If the initial X-rays do not clearly show a fracture but clinical suspicion is high, advanced imaging such as CT or MRI may be ordered to identify subtle or occult fractures and better assess the fracture’s location and severity.
3. Treatment Planning
- Discussion of Options: Your clinician will explain the treatment options, which could include immobilisation with casting, splinting, or surgical options in cases of more severe fractures.
- Casting or Splinting: For non-displaced fractures, a cast or splint is typically applied during the visit. The type and duration of immobilisation will be explained based on your specific fracture.
- Surgical Referral: If surgery is required, the clinician will discuss the procedure and expected outcomes and arrange for a surgical consultation.
4. Follow-Up and Recovery Plan
- Follow-Up Schedule: You’ll be scheduled for follow-up visits to monitor healing and, if necessary, adjust the treatment plan. Follow-ups typically involve repeat X-rays to confirm progress.
- Rehabilitation Guidance: Information on post-cast exercises or referral to physiotherapy is provided, especially if wrist mobility and strength need to be restored.
5. Education and Instructions
- Healing and Recovery Timeline: You’ll receive an overview of the expected recovery timeline and tips for managing pain, reducing swelling, and caring for the cast or splint.
- Red Flags: You’ll be informed of symptoms to watch for, such as increased pain, numbness, or swelling, which may indicate complications and require immediate attention.
A fracture clinic visit is designed to provide comprehensive care and a clear path toward healing tailored to your specific injury. The goal is to ensure effective management, reduce the risk of complications, and support a successful recovery. Access Ortho offers rapid appointments for orthopaedic injuries.

Commonly Asked Questions
Why Are Scaphoid Fractures Often Missed Initially?
Scaphoid fractures can be challenging to diagnose initially because they often don’t show up on standard X-rays right after the injury. Additionally, symptoms can be subtle, and some patients may still have relatively good wrist function, which can mask the severity of the injury.
Can I Still Move My Wrist if I Have a Scaphoid Fracture?
Yes, many people with a scaphoid fracture can still move their wrist and may not experience severe pain, which can lead to underestimating the injury. However, certain movements may be painful, especially those involving gripping or bending the wrist backward.
How Long Do I Need to Wear a Cast for a Scaphoid Fracture?
A cast is typically worn for 6–12 weeks for non-displaced scaphoid fractures. Fractures closer to the thumb side (distal pole) heal more quickly, while those closer to the forearm (proximal pole) may require longer immobilisation due to limited blood supply.
Will I Need Surgery for My Scaphoid Fracture?
Surgery may be recommended if the fracture is displaced, located in the proximal pole, or shows signs of non-union. In cases of non-displaced fractures, conservative treatment with casting is usually effective.
What Happens if a Scaphoid Fracture Is Left Untreated?
An untreated scaphoid fracture can lead to complications like non-union (failure of the bone to heal), avascular necrosis (bone death due to lack of blood supply), and Scaphoid Non-union Advanced Collapse (SNAC), which can cause chronic pain and arthritis.
Can I Work with a Scaphoid Fracture?
You may be able to work with a scaphoid fracture, depending on the nature of your job. If your work involves light activities, typing, or minimal wrist use, you might be able to continue. Physically demanding jobs or those requiring frequent wrist movements may need to be modified until healing is complete.
How Soon Can I Return to Sports After a Scaphoid Fracture?
Returning to sports can take several months. For non-displaced fractures treated with casting, a return might be possible in 8–12 weeks. If surgery is performed, return times vary, but patients are usually advised to wait until healing is confirmed and full wrist strength and mobility have returned.
Are Scaphoid Fractures Always Painful?
Scaphoid fractures can sometimes cause mild or intermittent pain, and some people may not realise they have a fracture until it’s diagnosed on imaging. Pain is usually felt on the thumb side of the wrist and may worsen with pressure or movement.
Can a Scaphoid Fracture Heal on Its Own Without Treatment?
Scaphoid fractures rarely heal properly on their own without treatment, particularly if they’re located in the proximal pole. Without proper immobilisation or surgical intervention, the risk of non-union and long-term complications is high.
What Exercises Can I Do to Regain Wrist Strength After a Scaphoid Fracture?
Once your fracture has healed, your doctor or physiotherapist may recommend gentle range-of-motion exercises like wrist flexion and extension, followed by progressive resistance exercises to restore grip strength and wrist stability. Therapy putty, hand grippers, or light dumbbells are commonly used to help regain strength safely.