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Scaphoid Fracture
Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board
A scaphoid fracture is one of the most common wrist injuries, usually from a fall on an outstretched hand.
The most common symptoms are wrist pain, just below the thumb, swelling and restricted movement.
The scaphoid bone plays a crucial role in wrist stability and function, and fractures to this small bone can lead to complications if not properly diagnosed and treated.
Scaphoid bone fractures cause outer wrist pain. If your pain is in a different part of your wrist, have a look at the central wrist pain and inner wrist pain articles.
In this article, we will look at what a scaphoid fracture is, common causes, symptoms, diagnosis, treatment options and recovery.
Scaphoid Anatomy
A scaphoid fracture is a common type of wrist fracture.
The wrist joint is found between the two forearm bones, the radius and ulna, and eight small hand bones, known as the carpal bones.
The carpal bones are arranged into two rows, with four bones in each row.
The scaphoid is a small, boat-shaped bone located on the thumb side of the wrist, just above the radius. It acts as a bridge between the carpal bones and the radius, contributing to wrist mobility and stability.
The scaphoid is positioned just below the base of the thumb and there is a simple way to find it.
- Make a fist and extend your thumb into a thumbs-up position, as if hitch-hiking
- A small triangular depression will appear at the base of your thumb, near the wrist between two tendons, known as the “anatomical snuffbox”
- If you press gently into this depression/hollow, you will be palpating directly over the scaphoid bone. Tenderness here is the most common sign of a scaphoid fracture.
What Is A Scaphoid Fracture?
A scaphoid fracture occurs when the carpal bone breaks, usually due to trauma. They are classified by the location and severity of the fracture.
Scaphoid bone fractures are classified by location into:
- Distal Pole Fractures: Located in the section of bone closest to the thumb. Good blood supply and excellent healing potential. Accounts for 20% of scaphoid fractures
- Waist Fractures: Occur in the middle of the bone and are the most common type (over 70%). Adequate blood supply with good healing potential
- Proximal Pole Fractures: Located near the forearm, these fractures have a higher risk of poor healing due to limited blood supply. Accounts for 10% of broken scaphoid
Depending on the location of the fracture, healing can be challenging due to the bone’s limited blood supply. Blood enters the scaphoid bone at the distal pole, nearest the thumb and travels through the bone towards the wrist. This means there is a much better blood supply in the distal pole and waist part of the bone than in the proximal pole which impacts healing.
Scaphoid fracture are also classified by severity:
- Non-Displaced Fractures: The bone fragments remain aligned in position
- Displaced Fractures: The bone fragments have shifted out of position. There may be gaps or overlapping between the fragments
Scaphoid fractures are the most common fractures of the carpal bones, accounting for approximately 60-70% of all carpal fractures.
Causes of Scaphoid Fractures
Scaphoid fractures typically result from trauma or forceful impact and common causes include:
- A Fall: on an outstretched hand (FOOSH) is the most common cause of scaphoid fracture. As you land, the weight goes through your palm and the force is transmitted to the scaphoid bone causing it to break. In some cases, the forearm bone may break as well, known as a distal radius fracture
- Sports Injuries: Contact sports, skateboarding, snowboarding, and gymnastics pose a higher risk due to falls and high-impact forces
- Motor Vehicle Accidents: Direct impact to the wrist during a crash can lead to a broken scaphoid
- Osteoporosis: Weakening of bones due to decreased bone density increases the risk of fractures, even with minor falls or impacts.
Scaphoid bone fractures are most frequently seen in young adults, particularly males between the ages of 15 and 30, due to their higher involvement in sports and high-impact activities.
Scaphoid Fracture Symptoms
Common symptoms of a broken scaphoid include:
- Pain in the Wrist: Outer wrist pain on the thumb side, which may worsen with thumb and wrist movements or when gripping objects
- Swelling & Tenderness: The area around the scaphoid may be swollen and tender to touch. The most classic sign of a scaphoid fracture is pain when pressing on the anatomical snuffbox
- Reduced Range Of Motion: thumb and wrist movements are often restricted due to pain and stiffness
Symptoms of a scaphoid fracture can be subtle, leading to delayed diagnosis. It is rare for there to be an obvious deformity or bruising with a scaphoid bone fracture, and as a result broken scaphoids are often misdiagnosed as a wrist sprain. The tell-tale sign is pain when you press on the anatomical snuffbox.
Fractured Scaphoid Diagnosis
Diagnosis of a scaphoid fracture typically involves:
Clinical Examination
The doctor will ask you questions about your symptoms such as when and how they started, any relevant medical history and previous wrist injuries. They will then carry out a physical examination to assess pain, tenderness, and range of motion. They will perform specific scaphoid fracture tests such as:
- Anatomical Snuffbox Test: pressing on the area at the base of the thumb elicits pain if a scaphoid bone fracture is present
- Scaphoid Tubercle Test: Pressing over the scaphoid tubercle on the front (palm side) of the wrist elicits pain
- Scaphoid Compression Test: Pushing down through the thumb metacarpal produces pain
These scaphoid fracture tests will elicit pain in 87-100% of cases of a broken scaphoid so they are extremely useful.
Imaging Tests
If your doctor suspects a scaphoid fracture, they will usually send you for imaging studies to confirm the diagnosis and the extent of the injury:
- Scaphoid Fracture X-rays: X-rays are the standard imaging to detect fractures, but in around 30% of cases, scaphoid bone fractures don’t show up clearly on them, particularly early on. These are called occult scaphoid fractures. If your symptoms and history indicate a likely fractured scaphoid but the x-ray is clear, you will be sent for further imaging studies
- MRI or CT Scan: These show the tissue around the bone and give a clearer picture on the location and extent of any damage
- Bone Scan: Occasionally used to identify small fractures that do not appear on other imaging tests.
If you have pain in your wrist after an injury that doesn’t settle down within 24hours, get checked out by a doctor as soon as possible as you may have a fracture.
Scaphoid Fracture Treatment
Treatment of a scaphoid fracture depends on factors such as the location of the fracture, the degree of displacement, and your overall health. Prompt and appropriate treatment is crucial to ensure proper healing and prevent complications.
Non-Surgical Treatment
Non-surgical treatment is recommended for non-displaced or minimally displaced fractured scaphoid, particularly those occurring in the distal pole (near the thumb) or waist (middle) of the scaphoid, as these have a better blood supply and heal more effectively.
- Casting or Splinting: A cast or splint is used to immobilize the wrist, typically covering the hand, thumb and forearm to the elbow. With waist and proximal pole fractures, the cast may extend past the elbow to restrict forearm rotation. If imaging is clear but a scaphoid fracture is still suspected, you may need to wear a cast or thumb spica splint for 2-3 weeks until you have a repeat x-ray
- Duration of Immobilization: Healing time varies but usually takes 8 to 12 weeks, depending on the location of the fracture. Distal pole fractures tend to heal faster, while fractures closer to the proximal pole take longer
- Follow-up X-rays & Imaging: Regular imaging helps track healing progress and determine when it is safe to remove the cast
- Activity Modification: Patients should avoid activities that place stress on the wrist, such as lifting heavy objects or participating in high-impact sports, until fully healed
Surgical Treatment
Scaphoid fracture surgery is recommended for displaced fractures, fractures in the proximal pole, or cases where treatment has failed to heal adequately.
- Reduction: In cases of displaced fractures, the bone fragments may need to be realigned before fixation. There are two options.
With a Closed Reduction the surgeon manipulates the wrist externally without making an incision, using traction and pressure to reposition the bone. This is often attempted under fluoroscopic (live X-ray) guidance.
If this is unsuccessful an Open Reduction is performed where an incision is made to directly access the bone fragments, allowing precise repositioning before fixation
- Internal Fixation: Once the bone fragments are aligned, the surgeon inserts small screws, pins, wires and/or a metal plate into the scaphoid to hold the bone in place and allow it to heal properly. This can be done through a percutaneous technique (minimally invasive) or an open surgical approach, depending on the fracture complexity
- Bone Grafting: If the fracture has poor healing potential (such as in cases of non-union or avascular necrosis), a bone graft may be taken from another part of the body (such as the hip or distal radius) to stimulate new bone growth.
After scaphoid fracture surgery you will need to wear a cast or splint for several weeks to protect the wrist and promote healing. Surgery is usually done as a day case so you can go home the same day.
Scaphoid Bone Fracture Recovery Time
Scaphoid fractures are often slow to heal and recovery varies based on fracture type and treatment:
- Non-Surgical Healing: Typically 6-12 weeks, depending on fracture location and immobilization.
- Post-Surgical Healing: May take 3-6 months, with physical therapy to restore wrist function.
- Rehabilitation: Gradual reintroduction of movement and strengthening exercises are essential for full recovery, with both surgical and non-surgical treatment. A physical therapist will work on a rehab program with you to help you regain full strength, flexibility and function in your wrist, hand and thumb.
Most people make a good recovery following a scaphoid fracture. Non-displaced distal and waist scaphoid bone fractures treated with immobilisation have an 88-95% success rate as long as treatment starts within 3 weeks of injury. Surgical treatments for scaphoid fractures have a 90-95% success rate.
The best way to ensure a good recovery from a broken scaphoid is:
- Early Diagnosis: early treatment leads to improved outcome
- Avoid Smoking & Drinking Alcohol: as these delay healing
- Avoid Heavy Lifting: don’t lift, carry or pull anything weighing more than 0.5kgs
- Avoid High Risk Activities: such as contact sports, skating, skiing, throwing or trampolining
Possible Complications
If not diagnosed and treated properly, scaphoid fractures can lead to several complications:
- Non-Union: Failure of the fracture to heal, often due to inadequate blood supply or delayed treatment. Occurs in 5-10% of cases following immobilisation (higher with proximal pole fractures)
- Avascular Necrosis (AVN): where the bone tissue dies due to lack of circulation. Scaphoid fractures in the proximal pole and displaced fractures are particularly at risk of AVN. Without proper treatment, almost all fractures in the proximal 5th will develop AVN and 33% in the proximal 3rd will
- Arthritis: Long-term untreated fractures or those that heal improperly can lead to wrist arthritis, causing chronic pain and stiffness
- Reduced Wrist Mobility & Strength: Poor healing or prolonged immobilization may result in lasting stiffness and weakness in the wrist, affecting daily activities
Scaphoid Fracture Summary
A scaphoid fracture is a common wrist injury that can lead to long-term complications if untreated.
The most common cause of scaphoid fractures is a fall onto an outstretched hand. They are often associated with other injuries, most typically a distal radius fracture.
Scaphoid bone fractures typically cause outer wrist pain that may radiate to the thumb. There may be localised swelling and difficulty moving the wrist and thumb.
Treatment may involve immobilisation or surgery, or a combination of both.
Early diagnosis, appropriate treatment, and adherence to rehabilitation guidelines are key to optimal recovery. With appropriate treatment, you have a good chance of making a full recovery from a fractured scaphoid, although it may take 3-6 months.
You may also be interested in the following articles:
- Inner Wrist Pain
- Central Wrist Pain
- Wrist Pain Diagnosis Charts
- Colles Fracture
- Carpal Tunnel Syndrome
- Forearm Pain
Related Articles
Medical & Scientific References
- Treatment of Scaphoid Fractures and Nonunions. Journal Of Hand Surgery
- Scaphoid Wrist Fracture. National Library Of Medicine
- Current Methods Of Diagnosis And Treatment Of Scaphoid Fractures. International Journal Of Emergency Medicine
Page Last Updated: March 6th, 2025
Next Review Due: March 6th, 2027
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