Georgios Panagopoulos MD | Orthopaedic Surgeon
A scaphoid fracture is a break in the scaphoid bone — one of the small carpal bones located on the thumb side of the wrist. It is the most common carpal bone fracture, typically occurring after a fall onto an outstretched hand (FOOSH injury). Because of its limited blood supply, this fracture carries a significant risk of delayed healing or nonunion if not properly diagnosed and treated.
Key takeaways at a glance
✅ Incidence: Most common carpal bone fracture, especially in patients aged 20-30 years.
✅ Mechanism: fall on the outstretched hand (FOOSH).
✅ Main symptoms: pain in anatomic snuffbox, swelling, weak grip.
✅ Diagnosis: clinical exam & imaging — xrays, MRI if needed.
✅ Treatment: ranges from casting to surgical fixation, based on fracture displacement.
✅ Healing: may take 6 weeks to 6 months
✅ Risks:Delayed diagnosis increases risk of nonunion and arthritis
Table of contents
What is a scaphoid fracture?
A scaphoid fracture is a break involving a bone of the carpus called the scaphoid. The scaphoid is located in the outer side of the wrist, between the thumb and the radius. It is called that way because it is thought to look like a boat. It also looks like a large cashew nut. This injury is notorious for not doing well, it can easily be missed or overlooked because of its subtle symptoms, and it may not heal properly as a consequence of the precarious blood supply of this bone.
Causes
A scaphoid fracture occurs more often in young and active individuals. The most common mechanism is a fall onto the outstretched hand. It can also occur during sporting activities or as a result of a road traffic accident.
Symptoms & clinical picture
The symptoms of a fractured scaphoid bone may include:
- Pain with gripping
- Swelling and bruising of the wrist
- Pain in the anatomical snuffbox
- Pain on the radial styloid
- Pain upon axial loading of the thumb
Symptoms may be very subtle initially. It is not uncommon for a scaphoid fracture to go undiagnosed for many months after the injury, or manifest itself many years later, after the development of wrist arthritis.
Diagnosis - why is a high index of suspicion needed?
The doctor will see you, take a detailed history and perform a physical exam, with care not to cause and further pain or discomfort. If a scaphoid fracture is suspected, x-rays of the area will be ordered (usually 3-4 high quality scaphoid views). Early on your fracture may not be visible. In case of a strong suspicion, even in the setting of normal initial x-rays, you may be placed in a cast and get a follow up in 10-14 days. At that point, a scaphoid fracture will be apparent on x-rays. Alternatively, your doctor may order an CT scan, or an MRI.
High index of suspicion!
Exam: snuffbox tenderness.
Xrays: often initially normal - rexray in 10-14 days upon strong suspicion.
MRI / CT: if xrays are negative, or in controversial cases.
Treatment
Each scaphoid fracture is different. Treatment may depend on time elapsed since the injury, degree of displacement, location of the fracture (distal, waist, proximal), prior treatment failure, etc. The scaphoid bone is notorious for not healing well due to its precarious blood supply. Casting is generally a safe and effective treatment for non-displaced fractures of the waist of the scaphoid. Casting time, however, may vary from 6 to 12 weeks. Your doctor will follow you with serial x-rays until bone healing is achieved clinically and radiologically.
Surgery is indicated for displaced fractures, fractures of the proximal pole of the scaphoid, or fractures that have failed to heal, or upon patient request if they want to get back to action as soon as possible (professional athletes or manual laborers). Surgery may be open or percutaneous based on the situation. If your scaphoid fracture fails to heal, you may have a scaphoid fracture nonunion.
A scaphoid nonunion needs to be treated surgically, because if left alone it will lead to wrist arthritis, a condition called SNAC wrist. This condition is painful and will compromise your whole wrist. Surgery of scaphoid nonunion involves open surgical fixation with bone graft, taken locally or from your pelvis. Grafts can be either vascularized or non-vascularized, with current studies showing no significant difference.
Treatment: Non-operative vs. Surgery
📌 Conservative treatment
Stable & undisplaced fractures:
- Splint/cast including the thumb for at least 6-12 weeks.
- Follow up with serial xrays.
🟠 Surgical treatment
For displaced fractures, unstable patterns, or if there is a high risk of nonunion:
- Surgical fixation with a headless compression screw +/- bone graft.
- Arthroscopy may be used as an aid.
It is imperative that you quit smoking, as this compromises any chance of healing by at least 50%. Often times, a scaphoid fracture may coexist with associated injuries, such as distal radius fractures or perilunate dislocations, that will necessitate surgical treatment in the same setting.
Dr Panagopoulos has extensive experience in the treatment of wrist fractures, and will discuss with you all options during your visit in our office.
A scaphoid fracture is not a simple "sprain" – it is a serious injury with predictable complications if not recognized and treated promptly and correctly. The choice of treatment depends on multiple factors and should be determined by a specialized orthopaedic/hand surgeon.
Expert Wrist Fracture Care in Athens
Dr Georgios Panagopoulos is an orthopaedic surgeon specializing in upper limb and arthroscopic procedures.
His experience in treating complex wrist fractures and scaphoid nonunions allows:
- Accurate early diagnosis
- Personalized treatment planning
- Prevention of long-term complications
- Faster recovery
Potential Risks & Complications
❗ Nonunion: Fracture fails to consolidate after initial treatment.
❗ Avascular necrosis (AVN): due to poor blood supply, especially in the proximal pole.
❗ Pain, dysfunction & early arthritis if treatment is delayed.
Scaphoid fracture - key facts
| Topic | Key Points |
|---|---|
| Definition | Break of the scaphoid bone at the wrist |
| Incidence | Very common, especially amongst the young |
| Causes | Fall on outstretched hand |
| Diagnosis | Exam, xrays, CT/MRI |
| Treatment | Cast or surgery |
| Healing | 6 weeks to 3 months |
| Risks | AVN, nonunion, arthritis |
FAQs - Frequently Asked Questions
What's the scaphoid?
The scaphoid is located in the outer side of the wrist, between the thumb and the radius. It is called that way because it is thought to look like a boat. It also looks like a large cashew nut.
Why is a scaphoid fracture so insidious?
This injury is notorious for not doing well, it can easily be missed or overlooked because of its subtle symptoms, and it may not heal properly as a consequence of the precarious blood supply of this bone.
What's the mechanism of injury?
A scaphoid fracture occurs more often in young and active individuals. The most common mechanism is a fall onto the outstretched hand.
What are the symptoms?
–Severe wrist pain
– Pain in the anatomical snuffbox
– Pain in the radial styloid
– Pain upon axial loading of the thumb
How is diagnosis made?
– History & clinical exam
– Xrays -> may be normal early on
– CT or MRI scan
What's the treatment?
Each scaphoid fracture is different. Treatment may depend on time elapsed since the injury, degree of displacement, location of the fracture (distal, waist, proximal), prior treatment failure, etc.
Duration of treatment - cast
Duration of treatment depends on many factors. You may need to stay in a cast for 6-12 weeks, until the fracture looks completely healed.
I have wrist pain after a fall, with normal xrays. Can I still have a scaphoid fracture?
Yes. Up to 20% of scaphoid fractures are not visible on initial X-rays. MRI is recommended if clinical suspicion remains high.
How long does it take to heal?
Healing depends on:
– Fracture location (proximal pole = higher risk)
– Displacement
– Smoking
Typically:
– 6–8 weeks for stable fractures
– 3–6 months for full recovery
When do I need surgery?
Surgery is usually needed in the following circumstances:
– DIsplacement >1mm
– Instability
– Delayed union
– Nonunion
– Need for timely recovery (i.e. athletes)
Surgery usually involves fixation with a headless compression screw.
What's a scaphoid nonunion?
Nonunion occurs when the fracture fails to heal, potentially leading to wrist collapse and arthritis if untreated.
Can I return to sports?
Return to sports is definitely possible, after fracture healing & appropriate physiotherapy.
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