Scaphoid Fracture

A scaphoid fracture is a break in the scaphoid bone, one of the small carpal bones in the wrist located near the base of the thumb. Despite its small size, the scaphoid plays a critical role in wrist motion and stability (1). Fractures to this bone are not uncommon and often result from falls onto an outstretched hand. Because of its unique blood supply, the scaphoid bone is prone to complications such as delayed healing or non-union, making timely diagnosis and treatment essential. While some fractures heal easily, others require surgical intervention, especially if left untreated or misdiagnosed initially.

Symptoms

Scaphoid fractures may not always present with dramatic symptoms, which can delay diagnosis. Common symptoms include

• Pain and tenderness: Usually on the thumb side of the wrist, especially in the “anatomical snuffbox” (a small hollow at the base of the thumb).
• Swelling: Mild to moderate swelling around the wrist or thumb (2).
• Difficulty gripping or moving the wrist: Some patients experience reduced strength and motion.
• Bruising: Less common but may appear in more severe fractures.
• Pain worsened by activity: Movements like grasping, lifting, or pushing can intensify discomfort.

In some cases, individuals may mistake a scaphoid fracture for a simple wrist sprain due to the subtle nature of symptoms (1).

Causes

Scaphoid fractures typically result from trauma or injury involving forceful impact to the wrist (3). Common causes include

• Falling on an outstretched hand (FOOSH injury): This is the most frequent cause, especially during sports or outdoor activities.
• Direct blow to the wrist: Less common but can occur during motor vehicle accidents or physical assaults.
• Twisting injuries: Sudden wrist torsion or forceful twisting can cause a fracture, although this is rare.

The scaphoid’s position and shape make it vulnerable during high-impact activities that involve the hands or wrists.

Risk Factors

Certain factors increase the likelihood of sustaining a scaphoid fracture

• High-impact sports: Athletes involved in football, basketball, skateboarding, snowboarding, and gymnastics are at greater risk (1).
• Younger age: Scaphoid fractures are more common in adolescents and young adults due to their active lifestyles and greater bone density.
• Male gender: Studies show higher incidence in males, potentially due to greater participation in high-risk activities.
• Previous wrist injuries: A history of wrist trauma can weaken the bone or increase susceptibility to re-injury.
• Occupational hazards: Jobs that involve physical labor or repetitive wrist strain may pose additional risk.

Diagnosis

Timely and accurate diagnosis is crucial for effective treatment and to prevent complications such as avascular necrosis (bone death due to interrupted blood flow) (3). Diagnostic steps include

• Physical Examination
  • Palpation of the anatomical snuffbox for tenderness.
  • Assessing wrist range of motion and grip strength.
  • Special tests like the Watson’s test to evaluate carpal stability.
• Imaging
  • X-rays: Initial imaging tool, although early fractures may not always be visible (4).
  • MRI (Magnetic Resonance Imaging): Highly sensitive, can detect early or occult fractures.
  • CT (Computed Tomography): Useful for assessing fracture alignment and planning surgical intervention.
  • Bone scan: Occasionally used when other imaging results are inconclusive.

If a fracture is suspected but not visible on the first X-ray, a splint may be applied and follow-up imaging done after 10 to 14 days (3).

Treatment Options

Treatment depends on the location, severity, and displacement of the fracture. Options range from conservative approaches to surgical intervention.

Non-Surgical Treatment

• Indicated for non-displaced fractures, especially in the distal third (closer to the thumb) (4).
• Immobilization
  • Use of a thumb spica cast or splint for 6–12 weeks.
  • Regular follow-up X-rays to monitor healing progress.
• Activity modification: Avoidance of activities that strain the wrist during the recovery period (3).

Surgical Treatment

• Recommended for displaced fractures, fractures in the proximal pole (closer to the forearm), or those that fail to heal with conservative treatment.
• Internal fixation
  • Screws or pins are used to stabilize the bone.
  • Minimally invasive techniques reduce recovery time (4).
• Bone grafting
  • In cases of non-union or poor healing, grafts may be taken from the patient’s own body or a donor to promote bone growth.

Rehabilitation

• Physical therapy is essential post-treatment to restore strength, mobility, and function.
• Gradual return to normal activities guided by a healthcare provider.

Living With or Prevention

While a scaphoid fracture can take time to heal, most people recover fully with proper care. However, it’s essential to take measures for long-term health and prevent recurrence (3).

Living With a Scaphoid Fracture

• Adhere to treatment: Wearing casts as prescribed and attending follow-up appointments are crucial.
• Avoid premature activity: Resuming activity too soon can delay healing or worsen the fracture (2).
• Monitor for complications: Look out for persistent pain, weakness, or stiffness which could indicate non-union or avascular necrosis (4).

Prevention Tips

• Protective gear: Use wrist guards during high-risk sports like skateboarding, rollerblading, or snowboarding.
• Fall prevention: Engage in exercises to improve balance and coordination (3).
• Workplace safety: Use ergonomically designed tools and take breaks to reduce repetitive strain.
• Strength training: Maintain strong wrist and forearm muscles to support and protect the bones.

References

1. Karimnazhand R, Shams R, Behmanesh A, Vosough M, Gharooee Ahangar A, Barrenechea LS, Mahmoudinasab O, Najd Mazhar F. Comparative efficacy of non-vascularized and vascularized bone grafts, with emerging insights into bone biomaterial grafts, in scaphoid fracture nonunion treatment: A systematic review and meta-analysis. J Orthop Translat. 2025 Jun 28;53:231-245. doi: 10.1016/j.jot.2025.06.009. PMID: 40678609; PMCID: PMC12269465.
2. Yang TH, Sun YN, Li RS, Horng MH. The Detection and Classification of Scaphoid Fractures in Radiograph by Using a Convolutional Neural Network. Diagnostics (Basel). 2024 Oct 30;14(21):2425. doi: 10.3390/diagnostics14212425. PMID: 39518391; PMCID: PMC11545356.
3. Samade R, Awan HM. Surgical Treatment of Scaphoid Fractures: Recommendations for Management. J Wrist Surg. 2024 Feb 9;13(3):194-201. doi: 10.1055/s-0043-1772689. PMID: 38808184; PMCID: PMC11129893.
4. Sailer S, Lechner S, Floßmann A, Wanzel M, Habeler K, Krasny C, Borchert GH. Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study. J Orthop Traumatol. 2023 Feb 10;24(1):6. doi: 10.1186/s10195-023-00686-7. PMID: 36765020; PMCID: PMC9916497.