Scaphoid Fractures

The scaphoid is a small, boat-shaped or peanut-shaped bone on the thumb side of the wrist. Despite its size, it plays a major role in wrist motion and stability. When the scaphoid breaks, prompt and precise treatment is important to prevent long-term problems.

Because scaphoid fractures can be subtle and sometimes do not show up on initial X-rays, they are occasionally missed or underestimated. My goal is early, accurate diagnosis and treatment that supports reliable healing.

History and Symptoms

Most scaphoid fractures occur after:

A fall onto an outstretched hand
Sports injuries, especially in contact or high-impact sports
Car, bike, or scooter accidents

Sometimes pain is immediate and obvious. Other times, symptoms are mild at first and dismissed as a “sprain.”

Swelling is not always so noticeable after a scaphoid fracture. These injuries might not always feel like a big deal.

Typical symptoms include:

Pain on the thumb side of the wrist, especially in the “snuffbox” area
Pain when gripping or lifting objects
Pain with pushing up from a chair or doing a push-up
Swelling around the wrist
Decreased range of motion

Any wrist pain that persists after an injury, particularly on the thumb side, deserves careful evaluation.

What is Unique About a Scaphoid Fracture

The scaphoid has a delicate blood supply that enters the bone in a way that can be disrupted by a fracture. If the blood flow is compromised, there is a risk of:

Delayed healing
Nonunion (failure of the bone to heal)
Avascular necrosis (bone collapse)
Progressive arthritis and long-term wrist pain

Because of this, scaphoid fractures are treated with closer monitoring than many other wrist fractures.

Diagnosing Scaphoid Fractures

Diagnosis includes:

A careful history of how the injury occurred
Physical exam focused on tenderness in specific areas around the scaphoid
Initial X-rays, often with special views

If X-rays are normal but suspicion remains high, further studies may include:

MRI: Very sensitive for detecting bone injuries early
CT scan: Helpful to assess fracture alignment and healing

It is better to temporarily treat a suspected scaphoid fracture as if it is fractured than to miss it and discover problems months later.

Treatment Options

Treatment depends on the location and pattern of the fracture, as well as how far the pieces have shifted.

Stable, Non-Displaced Fractures

For fractures in good alignment:

A cast or brace may be used to immobilize the wrist and thumb
Duration of immobilization varies, often over two months
Serial imaging monitors healing progress

Displaced or Unstable Fractures

If the fracture fragments are shifted or the pattern is higher risk for nonunion, surgery is often recommended.

Surgical options may include:

Percutaneous screw fixation: A small incision to place a screw across the fracture
Open reduction and internal fixation: A more direct approach when better visualization or grafting is needed
Bone grafting: In chronic, complex, or non-healing fractures

The goal is to restore alignment and provide stable fixation so the bone can heal in the best position possible.

Recovery and Long-Term Prognosis

Healing times vary. Factors include:

Fracture location
Degree of displacement
Smoking status
Age and overall health

Some fractures heal in a matter of weeks. Others, especially more complex injuries, can take several months and require careful follow-up.

When treated properly and monitored closely, many patients regain excellent wrist function and return to sports, work, and daily activities.

My Philosophy

I focus on:

Early, accurate diagnosis, even when the X-ray is not definitive
Clear communication about the risks and benefits of each treatment option
Individualized decisions about casting versus surgery
Close follow-up and imaging to confirm healing
Long-term protection of wrist function and comfort

The goal is not only to heal the bone, but to protect the long-term health of your wrist.