Scaphoid Fracture Info
Last reviewed
Scaphoid fractures — recognition, the high non-union risk, casting and percutaneous/open fixation.
What you're feeling
You likely feel pain and tenderness at the base of your thumb, right where your wrist meets your hand. This spot is often called the anatomical snuffbox. Even if your initial X-rays look normal, you might still have a true fracture. In fact, standard X-rays and two physical exams only identify a real break in about 40% of patients. If your pain persists, it is common for doctors to order an MRI scan to find these hidden injuries.
Your pain often flares up when you move your thumb or wrist. Simple daily tasks like reaching behind your back to fasten a bra or tucking in a shirt can become very difficult. You might find it hard to lift objects or grip things tightly. Many patients report that the pain gets worse at night or first thing in the morning. This discomfort can make it hard to sleep on your side or rest your hand comfortably.
While most children heal well with a cast, adults face a higher risk of the bone failing to heal. Even with proper treatment, more than 6% of these fractures do not join together properly. If the bone does not unite, you may need surgery to fix it. Until your surgeon confirms the bone has healed, you should be careful with how much you use your hand. It is important to follow their advice closely to avoid long-term problems.
What's actually happening
Your scaphoid is a small bone in your wrist that acts like a bridge between your hand and forearm. It has a delicate blood supply, which means it can struggle to heal on its own. When this bone breaks, the two pieces may not join together properly. This is called a nonunion. Even if the bone heals in a slightly crooked position, known as a malunion, you will likely still have good wrist function and strength over the long term.
If the bone does not heal, it changes how your wrist moves. The normal sliding motion between the bones in your wrist becomes uncoordinated. This can lead to pain and stiffness. However, many patients with fractures at the far end of the bone report normal hand function and good motion years later. In children, these fractures almost always heal with excellent results.
Your surgeon may use a bone graft to help the broken pieces knit back together. This involves taking a small piece of healthy bone to fill the gap and restore the shape of your wrist. This process helps relieve pain without limiting your ability to move your hand or grip objects. For most patients who achieve healing, the outcome is good regardless of how the bone aligned during the healing process.
What we can do about it
For many patients, especially children, the wrist heals well with simple care. You may start by resting the wrist and wearing a cast or splint to keep the bone still. Your surgeon might suggest seeing a physiotherapist to help you move safely and regain strength. This approach works well for fractures that have not moved out of place. However, if you take anti-inflammatory painkillers within the first month, you might face a higher risk of the bone failing to heal.
If the bone does not heal on its own, your surgeon may discuss surgery. This is often recommended if the fracture has moved out of place. For some recent fractures that have not healed, a minimally invasive procedure using bone graft and screws can help. While surgery often helps you return to work about seven weeks faster than non-surgical care, it does not guarantee a better long-term result for every patient. Even with the best care, more than 10% of surgical cases may still fail to heal.
Surgery is usually considered when conservative care has reached its limit or if the fracture is displaced. Your surgeon will weigh your personal values and risks to decide if an operation is right for you. There is no single best strategy for every case, so the plan depends on your specific situation. If the bone still does not heal after treatment, further procedures like removing part of the bone may be an option.
When to see someone
See your GP if you have wrist pain that does not improve with rest, or if you feel weakness, instability, or locking. Ask for a specialist review if symptoms interfere with sleep or work, or if you notice a sudden worsening. Be aware that standard X-rays and two clinical exams may miss the injury in about 60% of cases. If your first scan is normal but pain persists, ask about an early MRI to find hidden fractures. Delaying care for 21 days or more increases the risk of the bone failing to heal.
