Scaphoid Fracture Causes, Symptoms & Treatment Options

Overview

The scaphoid bone is one of the eight small carpal bones in the wrist that connect the forearm bones to the bones of the hand. These carpal bones are arranged in two rows: one closer to the forearm and one closer to the hand. The scaphoid is unique because it is the only carpal bone that spans both rows, playing a key role in wrist movement and stability. 

Because of this position, the scaphoid is especially vulnerable to injury during a fall onto an outstretched or extended wrist. In fact, it is the most commonly fractured carpal bone. Identifying a scaphoid fracture is important, as these injuries have a higher risk of delayed healing or nonunion if they are not diagnosed and treated promptly.

What causes Scaphoid Fracture?

Scaphoid fractures most commonly occur after a fall onto the palm of an outstretched hand. The position of the wrist and the force of impact transfer stress directly to the scaphoid bone, causing it to fracture. These injuries are common in sports where falls onto the hands are frequent.

How the Injury Occurs: A scaphoid fracture occurs when a sudden force travels through an extended wrist, concentrating stress on the scaphoid bone and causing it to crack or break.

Common Everyday Causes

• Slipping and falling on a hard surface
• Falling while walking or running
• Using the hands to break a fall
• Accidental trips on stairs or uneven ground

Scaphoid fractures may  occur in the following sports:

• Skiing, snowboarding: Falls at high speed often result in landing on an extended wrist.
• Skateboarding, in-line skating: Sudden loss of balance can cause a hard fall onto the hands.
• Bicycling: Riders often extend their hands instinctively to break a fall.
• Soccer: Falls or collisions can lead to landing on an outstretched hand.
• Football: Tackles and falls increase the risk of wrist impact injuries.
• Basketball: Jumping, rebounding, and falling can place force on the wrist during impact.

Symptoms

After a fall, patients usually notice wrist pain, but a scaphoid fracture may not cause clear symptoms at first. The pain can fade after a few days, leading some athletes to think they only have a wrist sprain.

You may have a scaphoid fracture if you have a history of a fall or other trauma and experience one or more of the following symptoms:

• Pain on the thumb side of the wrist – Discomfort is typically felt near the base of the thumb.
• Tenderness at the base of the thumb in the anatomical “snuff box” – Pain occurs in the hollow area on the outside of the hand formed by the thumb tendons.
• Swelling or bruising – Mild swelling or black-and-blue discoloration may appear, though it is often not severe.

Non-operative treatment

Treatment for a scaphoid fracture will depend on the location of the fracture, in part because the blood supply to the scaphoid varies for different locations of the bone. For example, fractures closer to the forearm are harder to heal because of the lack of blood supply to this area. The type of scaphoid fracture treatment will also be determined by the degree of displacement of the fractured bones. Non-displaced scaphoid fractures can be treated without surgery, as they typically heal with immobilization. Conservative treatment usually involves:

• Immobilizing the wrist with a splint for the first few days
• Switching to a cast once any swelling goes down, for six weeks to 3 months
• Intermittent x-rays to check fracture healing, and changing the cast if it gets loose
• Hand therapy after the cast comes off

Try these exercises to help address your condition:

Below is a PDF of the exercise program.

Scaphoid Fracture

Surgical Treatment

If your scaphoid fracture is displaced or located closer to the forearm, your doctor may recommend surgical treatment. Surgery is often advised when the broken bone pieces are not properly aligned or when healing is less likely with casting alone. During the procedure, metal screws or wires are used to hold the fractured bone in place so it can heal correctly. 

Surgical treatment often leads to better outcomes for displaced fractures and may reduce the length of time the wrist needs to be immobilized. Your orthopedic surgeon will discuss the most appropriate treatment option based on your fracture type and activity level.

VIDEO: “Scaphoid Fracture Open Reduction and Internal Fixation (ORIF)” from Viewmedica.com