Medically reviewed by: Mark A. Yaffe(opens in a new tab), MD — Board-Certified Orthopedic Surgeon, Subspecialty Certified in Hand Surgery
Key Takeaways
- The scaphoid is a small bone on the thumb side of the wrist, and a scaphoid fracture usually happens after a fall onto an outstretched hand.
- It is easy to mistake for a sprain, because the pain and swelling can be mild and the fracture may not show up on the first X-rays, so ongoing thumb-side wrist pain after a fall deserves a follow-up exam.
- Many stable, non-displaced fractures heal in a cast or splint that includes the thumb, while surgery is generally considered for displaced, unstable, or slow-healing fractures.
- The scaphoid has a limited blood supply, so it can heal slowly, and a missed or untreated fracture can fail to heal and lead to arthritis over time.
- Seeing a hand surgeon early, and getting repeat or advanced imaging if the pain continues, gives the bone the best chance of healing well.
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What Is a Scaphoid Fracture?
A scaphoid fracture is a break in the scaphoid, one of the small carpal bones of the wrist. The scaphoid sits on the thumb side of the wrist, just below the base of the thumb, and it acts as a link between the two rows of wrist bones. It is the carpal bone that breaks most often, and it can be injured on its own or together with other wrist fractures(opens in a new tab) such as a break of the radius, which is covered in this article on a broken wrist(opens in a new tab).
Because of its position and blood supply, the scaphoid behaves differently from most bones. Evaluating and treating it is part of broader hand and wrist(opens in a new tab) care, and early recognition makes a real difference to how well it heals.
What Causes a Scaphoid Fracture, and Who Is at Risk?
The usual cause is a fall onto an outstretched hand, which forces the wrist backward. Common situations include:
- Slips and falls on ice, wet floors, or uneven ground
- Falls from bikes, scooters, skateboards, and skis, as well as contact and ball sports injuries(opens in a new tab)
- Falls from a height or during work
- Direct blows to the wrist and car accidents
Scaphoid fractures are most common in active teens and younger adults, and they are less common in children and in older adults, who tend to break the radius instead.
Symptoms of a Scaphoid Fracture
Symptoms can be surprisingly mild at first, and they often include:
- Pain on the thumb side of the wrist, especially with gripping, pinching, or pushing up from a chair
- Tenderness in the hollow at the base of the thumb, known as the anatomical snuffbox
- Swelling on the thumb side of the wrist
- Reduced grip strength and reduced wrist motion
- Pain when bearing weight through the palm, such as in a push-up
Some people can still use the hand, which is one reason the injury is so often dismissed. Pain in the same area can also come from thumb arthritis(opens in a new tab) at the base of the thumb, so a persistent ache without a clear injury is worth sorting out with an exam.
How Is a Scaphoid Fracture Diagnosed, and Why Is It Missed?
A hand surgeon starts by asking how the injury happened and then presses on specific spots, including the snuffbox, to see whether they are tender. X-rays from several angles are the first imaging step. The challenge is that a small or non-displaced scaphoid fracture can be invisible on the first X-rays, and it may only appear after a week or two as the bone begins to heal.
That is why it is commonly mistaken for a wrist sprain(opens in a new tab). If the pain continues after a wrist injury, the next step may be a splint or cast and a repeat X-ray in 10 to 14 days, or an MRI or CT scan to look for a fracture sooner. For more on telling the difference, see this article on a fracture or sprain(opens in a new tab), and if you have just been injured, this guide on a suspected broken bone(opens in a new tab) explains what to do now. If you were seen at an emergency room first, this guide on post-ER care(opens in a new tab) covers the next steps.
Non-Surgical Treatment for a Scaphoid Fracture
Fractures that are non-displaced and stable, especially those in the middle of the bone, are often treated without surgery. Common approaches include:
- Immobilization: A cast or splint that includes the thumb, often called a thumb spica, holds the bone still while it heals. Fractures in the part of the bone with the weakest blood supply can need a longer time in the cast.
- Follow-up X-rays: Repeat imaging is used to confirm that the bone is lined up and healing, because a fracture can shift or fail to knit.
- Swelling control: Elevating the hand and moving the fingers helps reduce swelling and stiffness.
- Avoiding nicotine: Smoking and nicotine can slow bone healing, which matters in a bone that already heals slowly.
- Hand therapy: Once the bone is healed, therapy restores motion and strength. This article on hand therapy(opens in a new tab) explains how rehabilitation supports recovery.
Healing typically takes anywhere from several weeks to a few months, and it can take longer for fractures near the end of the bone closest to the forearm. Your surgeon will use imaging to decide when it is safe to come out of the cast.
Surgery for a Scaphoid Fracture
Surgery is generally considered when the fracture is displaced or unstable, when it involves the end of the bone closest to the forearm, when other wrist injuries are present, or when the bone has not healed after non-surgical treatment. The most common approach is to place a small screw across the fracture to hold the pieces together, which can allow the wrist to be protected for a shorter time than with a cast alone. For a fracture that has not healed, called a nonunion, bone graft may be added to help the bone heal. These are general descriptions, and the right option depends on the fracture and your health.
What to Expect During Recovery
After surgery, the wrist is protected in a splint or cast for a period, and hand therapy is usually started to restore motion and grip. Light daily activities often resume within a few weeks, while heavy lifting, weight-bearing, and contact sports may need to wait several months, until imaging shows the bone has healed. For a general picture of what recovery involves, see this overview of hand surgery recovery(opens in a new tab), and for how bones heal over time, see this article on the fracture healing timeline(opens in a new tab).
Risks and Possible Complications
The main concern with scaphoid fractures is that they may not heal, because the bone's blood supply is limited. A nonunion can cause ongoing pain and weakness, and a section of bone can lose its blood supply, a problem called avascular necrosis. Over time, a nonunion can change how the wrist bones move and lead to arthritis, which is covered in this article on wrist arthritis(opens in a new tab) and on the page about advanced wrist arthritis(opens in a new tab). Surgery carries its own risks, including stiffness, hardware irritation, infection, and nerve irritation. Your surgeon will review the benefits and risks before you decide.
When to See a Hand Surgeon
See a hand surgeon if you have pain on the thumb side of the wrist after a fall, especially if there is tenderness at the base of the thumb or the pain hasn't improved after a week or two. A normal first X-ray doesn't rule out a scaphoid fracture. Seek care right away for numbness, fingers that look pale or cold, or an open wound.
Dr. Yaffe sees patients in Schaumburg(opens in a new tab), Elk Grove Village(opens in a new tab), and Buffalo Grove(opens in a new tab). To get started, schedule an appointment(opens in a new tab) online, and it helps to note how and when you were injured and where the pain is felt.
Frequently Asked Questions
Can you have a scaphoid fracture and not know it?
Yes. Symptoms can be mild enough that the injury feels like a sprain, and some people keep using the hand. Pain on the thumb side of the wrist that lasts more than a week or two after a fall is worth having examined.
Why is a scaphoid fracture missed on X-ray?
A small crack, or a fracture in which the bone stays in position, may not be visible on the first X-rays. The break often becomes easier to see after a week or two, and an MRI or CT scan can show it earlier. Because of this, doctors often splint the wrist and repeat the X-ray when a scaphoid fracture is suspected.
How long does a scaphoid fracture take to heal?
A scaphoid fracture often takes about six to twelve weeks to heal, and it can take longer, particularly for fractures near the end of the bone closest to the forearm. Healing time varies, and imaging is used to confirm that the bone has healed before returning to full activity.
Do I need surgery for a scaphoid fracture?
Not always. Stable, non-displaced fractures often heal in a cast or splint, while displaced, unstable, or slow-healing fractures are more likely to need surgery. A hand surgeon can review your imaging and explain which option fits your fracture.
What happens if a scaphoid fracture is left untreated?
An untreated scaphoid fracture can fail to heal, causing ongoing pain and weakness and a higher chance of arthritis in the wrist over time. Early diagnosis and treatment lower this risk, although some untreated fractures can still be treated later.
