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舟骨骨折

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Scaphoid fractures — recognition, the high non-union risk, casting and percutaneous/open fixation.

Updated Jun 2026
一幅手绘插图，描绘了一个没有面部特征的人向前绊倒并摔倒，伸出的一只手撑在地上以缓冲摔倒。
X线显示腕部舟骨骨折。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到拇指根部、腕部下方的疼痛和压痛。该区域被称为鼻烟壶。疼痛通常始于摔倒时手掌撑地之后。您可能会注意到腕部周围出现肿胀或瘀伤。简单的日常活动可能会变得困难。将手伸到背后扣内衣可能会引起疼痛。塞衬衫或转动门把手可能会引发剧烈不适。提起物体，即使是轻物，也可能感觉不稳定或疼痛。

疼痛通常在活动时加重。拇指和腕部同时使用会对受伤的骨骼造成压力。您可能会发现难以牢固地抓握物品。这会使握住咖啡杯或手机变得困难。休息手部通常有助于减轻酸痛。然而，在您活动后，疼痛可能在一天晚些时候加剧。一些患者报告说，夜间不适感明显，尤其是如果您侧卧睡在该侧。醒来时腕部僵硬或酸痛很常见。

重要的是要知道，标准X光片并不总能清晰地显示骨折。事实上，仅根据初始X光片和临床检查，只有约40%的患者被确诊为真正骨折。这意味着即使第一次扫描看起来正常，您的症状可能感觉严重。如果您的外科医生怀疑骨折但X光片不明确，他们可能会安排MRI检查。这种扫描可以发现X光片遗漏的隐匿性损伤。早期诊断有助于预防并发症。

如果骨骼未能正确愈合，可能导致骨不连。这发生在骨骼未能重新连接在一起时。舟骨骨折的骨不连率仍然很高。在某些情况下，即使经过适当的初始治疗，延迟愈合或骨不连的发生率仍超过6%。大多数这些患者需要手术来修复骨骼。早期内固定越来越受到青睐，以降低这种风险。您的外科医生将根据您损伤的具体情况讨论最佳治疗方案。

实际发生了什么

您的舟骨是腕部一块形似核桃的小骨。它充当前臂骨与手部骨骼之间的重要桥梁。该骨的血液供应较为复杂，意味着它并不总能获得足够的营养以自行愈合。当舟骨骨折时，愈合过程可能会停滞。这被称为骨不连。即使采用现代诊断和手术技术，骨不连的发生率仍然很高。

如果骨头未能重新连接，腕部的正常运动就会发生改变。腕骨本应像协调的舞蹈一样运动。舟骨骨折会打破这种节奏。它使腕骨的上排和下排部分解耦。这会导致关节面出现异常运动和磨损。随着时间的推移，这种磨损可能导致关节炎。当关节面在没有通常光滑保护的情况下相互摩擦时，您可能会感到疼痛和僵硬。

您的外科医生可以帮助恢复这种平衡。对于某些骨折，简单的螺钉即可将碎片固定在一起，直至愈合。对于更复杂的情况，您的外科医生可能会使用骨移植。这涉及取一小块健康骨以填补空隙并促进生长。在某些情况下，您的外科医生还可能调整前臂骨的形状。这将把重量从受损的舟骨上转移开。这些步骤旨在恢复正常的腕部运动和握力。

目标是阻止异常磨损，以免造成长期损伤。如果早期治疗，即使是移位的骨折也能很好地愈合。如果骨头成功连接，无论形状是否有轻微改变，您很可能都会获得良好的预后。重点是为提供一个无痛且功能正常的腕部，使其能够胜任日常任务，而不会因“断裂的桥梁”导致研磨感或不稳定。

我们能采取的措施

您的治疗始于仔细监测和休息。由于标准X光片和两次临床检查仅能识别约40%患者的真正骨折，您的外科医生可能会使用早期MRI来获得明确诊断。该扫描能准确发现隐匿性损伤，并在初始结果不明确时帮助排除骨折。在等待诊断或进行保守治疗期间，您应避免对腕部造成应力的活动。物理治疗旨在骨骼愈合后恢复您的活动范围和力量。对于许多患者，尤其是无移位骨折患者，非手术治疗是有效的。此类病例的骨愈合率接近甚至超过手术治疗。您预计需要佩戴石膏或夹板，具体时长由您的外科医生决定。在任何手术后，腕部固定时间没有单一的最佳方案，因此您的医疗团队将根据您的愈合进展为您提供指导。

疼痛管理是康复的关键部分。您的外科医生可能会推荐非处方止痛药以保持舒适。然而，您必须谨慎使用非甾体抗炎药（NSAIDs）。如果在受伤后的第一个月内服用这些药物，您将面临骨不愈合（nonunion）风险增加的可能性。这种失败可能导致后续更复杂的补救手术。对于大多数急性骨折，我们不将可的松、透明质酸或富血小板血浆（PRP）注射作为常规治疗。相反，我们专注于在骨骼自我修复过程中提供保护。如果您患有无移位且无成角畸形的骨不连，可能会考虑微创骨移植和加压螺钉固定。这种方法无需大手术即可安全有效地稳定骨骼。

手术通常保留用于移位骨折或保守治疗失败的病例。如果您的骨折发生移位，建议进行手术干预以正确对齐骨骼。对于初始治疗未愈合的近期骨不连，您的外科医生可能会进行远端舟骨切除术，或使用双抗旋转螺钉固定结合关节镜技术。这些手术旨在稳定骨骼并促进愈合。虽然早期内固定越来越受到某些急性骨折的青睐，但对于无移位损伤并非总是必要。事实上，与急性无移位或轻微移位骨折的非手术治疗相比，手术并无真正的长期益处。您的外科医生将根据您的个人价值观和风险承受能力帮助您选择治疗方案。请记住，即使采用改进的技术，骨不连的发生率仍然很高，因此无论选择何种治疗，密切随访都至关重要。

预期情况

大多数舟骨骨折愈合良好，尤其是在儿童中。对于成年人，预后取决于治疗的及时性以及骨块是否发生移位。如果骨折没有移位或仅有轻微移位，外科医生可能会建议打石膏固定或手术治疗。这两种方法在长期功能恢复方面效果相似。然而，与单纯石膏固定相比，手术治疗可帮助患者提前约 7 周重返工作岗位。

如果骨骼未能愈合，则称为骨不连。在闭合性骨折手术后，这种情况的发生率超过 10%。如果受伤后超过 21 天才就诊，骨不连的发生率也更高。延迟治疗会增加石膏固定失败的风险。骨不连可能导致腕部进行性磨损性关节炎。虽然这听起来很严重，但许多患者在多年后仍报告腕关节活动度和力量良好，即使骨骼形状略有改变。

您的外科医生会密切监测您的愈合情况。如果发生骨不连，可能需要进行进一步的手术。这些重复手术的成功率低于首次手术。在某些已发生关节炎的情况下，切除部分舟骨可以缓解疼痛。约 94% 的患者对这一手术表示满意，且该手术可防止腕部进一步塌陷。

总体而言，几乎所有成功愈合的舟骨骨折都能带来良好的预后。关键在于确保骨骼愈合。早期诊断至关重要，因为标准 X 线检查经常漏诊此类损伤。如果您属于愈合延迟风险较高的群体，例如患有某些精神健康状况或来自贫困社区的人群，加强随访非常重要。通过适当的护理，您可以在未来几个月内期望恢复正常的双手功能和力量。

何时就诊

如果您手腕持续疼痛、无力或不稳，请就诊全科医生。影响睡眠或工作的症状需要关注。如果手腕出现卡住或突然无力，请要求专科医生评估。疼痛突然加重也是一个警示信号。请注意，受伤后延迟就诊21天或以上会增加石膏固定失败的风险。误诊的骨折可能导致严重并发症。早期诊断有助于避免这些问题。如果初始X线检查不明确，早期MRI可准确识别损伤。不要忽视症状，因为未经治疗的骨折可能无法正确愈合。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

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Evidence & references

Overview

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series [2].
  • The clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases [15].
  • Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture [17].
  • The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully [14].
  • Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures [24].
  • This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • For all indications, the scaphoid staple has a high union rate and a low complication rate [6].
  • Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection [25].
  • Despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures [28].

Anatomy & Pathophysiology

  • The scaphoid is critical to the coordination of normal carpal kinematics [34].
  • Scaphoid fracture has significant biomechanical consequences to the wrist [34].
  • Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows [35].
  • Problem fractures and non-unions of the scaphoid are associated with major alterations in wrist kinematics [46].
  • Problem fractures and non-unions of the scaphoid are associated with a higher incidence of premature carpal collapse and degenerative arthritis than previously appreciated [46].
  • A foreshortened healed scaphoid will disrupt carpal kinematics [37].
  • A foreshortened healed scaphoid negatively impacts results, including decreased wrist range of motion and diminished grip strength [37].
  • Malunion or nonunion of an acute scaphoid fracture can lead to abnormal carpal kinematics and wrist arthrosis [61].
  • Radiocarpal-based lunate morphology was not associated with scaphoid fracture [74].
  • Anomalous carpal kinematics caused by lunotriquetral coalition may have predisposed both scaphoid bones to fracture, although causality cannot be proven [78].

Classification

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series [2].
  • The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients [3].
  • If there is a strong clinical suspicion of a scaphoid fracture which cannot be confirmed by conventional radiology, bone scintigraphy is a valuable diagnostic tool [8].
  • The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures [9].
  • There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced' [10].
  • Due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance, 6-week radiographs are not adequate for evaluating suspected scaphoid fractures [12].
  • Scaphoid fractures account for 2% of all fractures and are the most commonly injured carpal bone [13].
  • The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully [14].
  • Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases [15].
  • Despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures [28].
  • There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies [41].
  • The authors hypothesise higher union rates in scaphoid fractures using more stable fixation systems [79].
  • Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data [80].

Clinical Presentation

  • Scaphoid fractures account for 2% of all fractures and are the most commonly injured carpal bone [13].
  • Most scaphoid fractures are missed due to failure to consider the possibility of the injury and search for clinical signs [19].
  • The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients [3].
  • The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures [9].
  • 6-week radiographs are not adequate for evaluating suspected scaphoid fractures due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance [12].
  • Ultrasonic assessment is not recommended for the early diagnosis of acute scaphoid fractures, with a sensitivity of only 50% and five missed scaphoid fractures in a small series [39].
  • If there is a strong clinical suspicion of a scaphoid fracture which cannot be confirmed by conventional radiology, bone scintigraphy is a valuable diagnostic tool [8].
  • Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture [20].
  • The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries [23].
  • MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union [22].
  • The diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture [40].
  • There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced' [10].
  • Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage [16].

Investigations

  • Conventional radiographs combined with two clinical examinations provide inadequate diagnostic certainty for scaphoid fractures, identifying a true fracture in only about 40% of patients [3].
  • The combination of conventional radiographs and clinical reassessment does not increase diagnostic accuracy compared to conventional radiographs alone [9].
  • There is no consensus on the imaging modality or measurements used to define a scaphoid fracture as nondisplaced [10].
  • Six-week radiographs are not adequate for evaluating suspected scaphoid fractures due to low inter-observer agreement and poor diagnostic performance [12].
  • Most missed scaphoid fractures result from a failure to consider the injury possibility and search for clinical signs [19].
  • Clinical examination combined with early MRI scan should form the basis for diagnosing suspected scaphoid fractures [20].
  • MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion occurring in over 6% of cases despite appropriate initial immobilization [22].
  • Most patients with nonunion of MRI-detected scaphoid fractures require surgery to achieve union [22].
  • Early MRI in patients with clinically suspected scaphoid fractures accurately and reliably identifies a significant number of radiological occult injuries [23].
  • Early MRI in patients with clinically suspected scaphoid fractures allows for the early identification of patients without acute injuries [23].
  • Early MRI provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive [56].
  • Early MRI for suspected scaphoid fractures when initial radiographs are inconclusive is cost-effective and minimizes complications [56].
  • CT is a good way to screen for occult fractures but may not be superior to MRI or bone scanning in detecting scaphoid fractures without causing overtreatment [58].
  • Multidetector computed tomography (MDCT) has a sensitivity of 86% and specificity of 100% for detecting occult scaphoid fractures in patients with negative radiographic examinations [59].
  • MRI is the optimal second test for assessing a possible scaphoid fracture after a negative radiograph [60].
  • CT is preferred over MRI when the fracture is visible for further assessment and surgical planning [60].
  • There is variation in definitions of scaphoid fractures on MRI scans, highlighting a need for consensus to assess reliability and diagnostic performance [63].
  • Bone scintigraphy is inappropriate for evaluating specificity and sensitivity against clinical examination [64].
  • MRI is the recommended examination of choice for diagnosing occult scaphoid fractures over bone scintigraphy [64].
  • MRI is considered the best diagnostic radiological test for triage of suspected scaphoid fractures according to existing literature [67].
  • Bone scanning, CT, and ultrasound may be useful for suspected scaphoid fractures when MRI is not readily available [67].
  • Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment [72].
  • Nearly 70% of MRI findings in suspected scaphoid fractures are categorized as distracting and potentially misleading [72].
  • Stopping the pursuit of occult fractures may prevent unnecessary treatment due to the risk of overdiagnosis with routine MRI [72].
  • Better standardization of MRI definitions for scaphoid fractures is required to address diagnostic uncertainty [76].
  • A definitive definition may not exist to solve the potentially unsolvable issue of diagnostic uncertainty in scaphoid fractures [76].
  • Patients should participate in decisions regarding diagnostic and treatment strategies for scaphoid fractures due to diagnostic uncertainty [76].
  • MRI is not 100% specific for diagnosing occult scaphoid fractures, with a specificity of 96% in healthy volunteers [77].

Treatment

Nonoperative Management

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases [15].
  • Early treatment of acute scaphoid fractures is important, with union rates significantly greater when treatment is instituted prior to 4 weeks from injury [26].
  • Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures [24].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks) [21].
  • This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [18].
  • Non- and minimally displaced scaphoid waist fractures are best treated conservatively [36].
  • Non-operative treatment of non-displaced scaphoid fractures may be preferred [53].
  • A restricted period of cast immobilisation is usually adequate for the treatment of non-displaced scaphoid fractures [53].
  • Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients to reduce the period of cast immobilization [57].
  • The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully [14].
  • Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures [51].
  • Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series [2].
  • Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures [54].

Operative Management

  • Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture [17].
  • The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period [11].
  • For all indications, the scaphoid staple has a high union rate and a low complication rate [6].
  • The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective [44].
  • Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection [25].
  • The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial [62].

Special Populations and Considerations

  • The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis [55].
  • The clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • This case is interesting as the child is one of the youngest patients described in the literature with a scaphoid fracture, and the fracture went on to non-union despite immediate medical attention and rigorous treatment [49].
  • The authors argue that comfort with uncertainty is key in suspected scaphoid fracture scenarios, as there is no best strategy; instead, clinicians should help patients choose a diagnostic and therapeutic course based on their individual values and risk tolerance [66].

Complications

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Many decisions regarding scaphoid fracture management are based on small case series due to insufficient evidence for well-established principles [2].
  • The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients [3].
  • Clinical outcomes of malunited scaphoids after reconstruction for scaphoid fracture nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • There is no true long-term benefit of internal fixation compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • The scaphoid staple has a high union rate and a low complication rate for all indications [6].
  • Subacute scaphoid fractures presenting within 6 months from injury can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed [7].
  • The frequency of nonunion after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period [11].
  • Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage [16].
  • Appropriately performed acute percutaneous internal fixation is a standard treatment option for a selected group of patients with acute scaphoid fracture [17].
  • There is no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [18].
  • Persistent nonunion is common after surgery for scaphoid nonunion, and surgeries for persistent nonunion are even less successful [27].
  • Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure, although the union rate remains high with comparable time in cast [29].
  • Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but had overall good clinical results on midterm follow-up [30].
  • Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid [32].

Recovery

  • Pediatric scaphoid fractures have excellent outcomes [1].
  • Clinical outcomes of malunited scaphoids after reconstruction for nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up [4].
  • There is no true long-term benefit of internal fixation compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [5].
  • The scaphoid staple has a high union rate and a low complication rate for all indications [6].
  • Subacute scaphoid fractures presenting within 6 months from injury can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed [7].
  • The frequency of nonunion after surgical management for closed scaphoid fractures exceeds 10% [11].
  • Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage [16].
  • There is no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [18].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years) [21].
  • Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures results in a significantly faster return to work (SMD of 7 weeks) [21].
  • Union rates are significantly greater when treatment is instituted prior to 4 weeks from injury [26].
  • Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful [27].
  • Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure [29].
  • The union rate remains high with comparable time in cast despite delayed presentation of scaphoid fractures 21 days or more after injury [29].
  • Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging [30].
  • Patients with malunited acute scaphoid fractures demonstrated overall good clinical results on midterm follow-up despite radiographic findings of early arthritis [30].
  • From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function [31].
  • From an 8- to 11-year perspective, patients with distal scaphoid fractures report good wrist motion and strength [31].
  • Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury [32].
  • Increased likelihood for nonunion was found when fracture volume was less than 38% of the entire scaphoid [32].
  • Patients treated nonoperatively or with salvage procedures had similar long-term outcomes as those treated with a corrective scaphoid osteotomy [65].
  • Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union [83].
  • Dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture viability assessment using contrast-enhanced MRI [84].
  • Scaphoid nonunions demonstrate findings indicative of progression to union on CT at a mean of 6 weeks [86].
  • Scaphoid nonunions demonstrate findings indicative of progression to union on CT as early as 3 weeks postoperatively [86].

Key Evidence

  • [L1] Pediatric scaphoid fractures have excellent outcomes. [1] (10.1177/1558944717735948)
  • [L5] Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series. [2] (10.1177/1753193420977241)
  • [L5] The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients. [3] (10.1097/corr.0000000000002413)
  • [L4] The clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. [4] (10.1016/j.otsr.2014.09.026)
  • [L1] This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. [5] (10.2106/jbjs.g.00673)
  • [L4] For all indications, the scaphoid staple has a high union rate and a low complication rate. [6] (10.1177/1558944716658747)
  • [Paper] If there is a strong clinical suspicion of a scaphoid fracture which cannot be confirmed by conventional radiology, bone scintigraphy is a valuable diagnostic tool. [8] (10.1016/j.injury.2005.02.009)
  • [L2] The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures. [9] (10.1097/corr.0000000000002310)
  • [L5] There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced.' [10] (10.1016/j.jhsa.2012.10.025)
  • [L3] The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period. [11] (10.1016/j.jhsa.2015.06.019)
  • [L2] Due to low agreement between observers for the recognition of scaphoid fractures and poor diagnostic performance, 6-week radiographs are not adequate for evaluating suspected scaphoid fractures. [12] (10.1007/s00402-016-2438-4)
  • [L5] Scaphoid fractures account for 2% of all fractures and are the most commonly injured carpal bone. [13] (10.1016/j.hcl.2017.04.003)
  • [L5] The definition of instability of scaphoid fractures and the indications for conservative treatment must be considered carefully. [14] (10.1142/s0218810415400018)
  • [L5] Internal fixation of scaphoid fractures is indicated in certain acute situations and in chronic nonunion cases. [15] (10.1016/s0749-0712(21)00118-9)
  • [L4] Oblique scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage. [16] (10.1016/j.injury.2009.07.078)
  • [L4] Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture. [17] (10.5435/00124635-200708000-00004)
  • [L1] We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. [18] (10.1302/0301-620x.104b8.bjj-2022-0085.r2)
  • [L4] Most scaphoid fractures were missed due to failure to consider the possibility of the injury and search for clinical signs. [19] (10.1016/j.injury.2019.05.009)
  • [L3] Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture. [20] (10.1177/1753193420979465)
  • [L1] Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks). [21] (10.1136/jisakos-2015-000024)
  • [L3] MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. [22] (10.1302/0301-620x.106b4.bjj-2023-1171.r1)
  • [L2] The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries. [23] (10.1177/1753193412471008)
  • [L1] Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures. [24] (10.2106/jbjs.rvw.15.00073)
  • [L4] Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection. [25] (10.1016/j.jhsg.2024.03.013)
  • [L5] Early treatment of acute scaphoid fractures is important, with union rates significantly greater when treatment is instituted prior to 4 weeks from injury. [26] (10.1016/s0749-0712(21)00580-1)
  • [L4] Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful. [27] (10.1016/j.jhsa.2015.06.022)
  • [L5] This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions, highlighting that despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures. [28] (10.1016/j.jhsa.2008.04.026)
  • [L4] Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast. [29] (10.1016/j.jhsa.2023.10.020)
  • [L4] Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but overall good clinical results on midterm follow-up. [30] (10.1016/j.jhsa.2020.04.002)
  • [L2] From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. [31] (10.1016/j.jhsa.2017.06.016)
  • [L5] The scaphoid is critical to the coordination of normal carpal kinematics, and its fracture has significant biomechanical consequences to the wrist. [34] (10.1016/s0749-0712(21)01439-6)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [35] (10.1016/j.jhsa.2008.03.008)
  • [L2] Non- and minimally displaced scaphoid waist fractures are best treated conservatively. [36] (10.1016/j.jhsa.2015.03.007)
  • [L5] All scaphoid fractures that heal do not yield acceptable results, as a foreshortened healed scaphoid will disrupt carpal kinematics and negatively impact results, including decreased wrist range of motion and diminished grip strength. [37] (10.1016/s0749-0712(21)01437-2)
  • [L4] With a sensitivity of only 50% and five missed scaphoid fractures in this small series, we can not recommend ultrasonic assessment for the early diagnosis of acute scaphoid fractures. [39] (10.1054/jhsb.2000.0432)
  • [L4] The diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture. [40] (10.1302/0301-620x.102b4.bjj-2019-0632.r3)
  • [L4] There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies. [41] (10.1177/1753193417739510)
  • [L4] The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective. [44] (10.1016/j.jhsa.2014.02.030)
  • [L5] Problem fractures and non-unions of the scaphoid are associated with major alterations in wrist kinematics and a higher incidence of premature carpal collapse and degenerative arthritis than previously appreciated. [46] (10.2106/00004623-199274030-00014)
  • [L4] This case is interesting as the child is one of the youngest patients described in the literature with a scaphoid fracture, and the fracture went on to non-union despite immediate medical attention and rigorous treatment. [49] (10.2106/00004623-198365080-00026)
  • [L1] Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures. [51] (10.1007/s11552-010-9276-6)
  • [L4] A restricted period of cast immobilisation is usually adequate for the treatment of non-displaced scaphoid fractures. [53] (10.1016/j.injury.2008.10.028)
  • [L2] Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures. [54] (10.1016/j.jhsg.2026.100958)
  • [L4] The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis. [55] (10.1016/s0749-0712(21)00181-5)
  • [L5] Early magnetic resonance imaging (MRI) provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive, which is cost-effective and minimizes complications. [56] (10.1016/j.jhsa.2013.03.055)
  • [L5] Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients to reduce the period of cast immobilization. [57] (10.5435/00124635-200007000-00003)
  • [Commentary] CT is a good way to screen occult fractures but may not be any better than MRI or bone scanning in detecting scaphoid fractures without some over treatment. [58] (10.1177/1753193412446273)
  • [L2] Although MRI remains the best diagnostic tool after radiography for detecting occult scaphoid fractures, MDCT sensitivity was 86% and specificity was 100% in this study. [59] (10.1007/s11604-010-0520-3)
  • [Paper] MRI is the optimal second test for assessing a possible scaphoid fracture after a negative radiograph, while CT is preferred when the fracture is visible for further assessment and surgical planning. [60] (10.1016/j.hcl.2019.03.001)
  • [L5] Early diagnosis and vigilant care of an acute scaphoid fracture are warranted to prevent malunion or nonunion, which can lead to abnormal carpal kinematics and wrist arthrosis. [61] (10.2106/00004623-200612000-00026)
  • [L4] The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. [62] (10.1177/15589447221093675)
  • [L3] This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits. [63] (10.1177/17531934251367541)
  • [L5] The authors argue that bone scintigraphy is inappropriate for evaluating specificity and sensitivity against clinical examination, and that MRI is the recommended examination of choice for diagnosing occult scaphoid fractures. [64] (10.1016/j.injury.2007.12.013)
  • [L4] Patients treated nonoperatively or with salvage procedures had similar long-term outcomes as those treated with a corrective scaphoid osteotomy. [65] (10.1177/1558944716643295)
  • [L5] The authors argue that comfort with uncertainty is key in suspected scaphoid fracture scenarios, as there is no best strategy; instead, clinicians should help patients choose a diagnostic and therapeutic course based on their individual values and risk tolerance. [66] (10.1097/corr.0000000000003141)
  • [L5] According to the existing literature, MRI is the best diagnostic radiological test for triage of suspected scaphoid fractures, but bone scanning, CT, and ultrasound may also be useful, particularly when MRI is not readily available. [67] (10.1016/j.jhsa.2008.04.016)
  • [L5] Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment, with nearly 70% of MRI findings categorized as distracting and potentially misleading, suggesting that stopping the pursuit of occult fractures may prevent unnecessary treatment. [72] (10.1097/corr.0000000000002914)
  • [L3] By contrast, radiocarpal-based lunate morphology was not associated with scaphoid fracture. [74] (10.1016/j.jhsa.2025.10.018)
  • [L5] The authors argue that better standardization of MRI definitions for scaphoid fractures is required, but acknowledge that a definition may not exist to solve the potentially unsolvable issue of diagnostic uncertainty, suggesting patients should participate in decisions regarding diagnostic and treatment strategies. [76] (10.1177/17531934251394819)
  • [Paper] MRI is not 100% specific for diagnosing an occult scaphoid fracture, with a specificity of 96% in healthy volunteers. [77] (10.1016/s0363-5023(10)60085-8)
  • [L4] The patient may represent two isolated coexisting conditions, or the anomalous carpal kinematics caused by the lunotriquetral coalition may have predisposed both scaphoid bones to fracture, although causality cannot be proven. [78] (10.1016/j.jhsa.2015.07.003)
  • [Paper] The authors hypothesise higher union rates in scaphoid fractures using more stable fixation systems. [79] (10.1007/s00402-016-2556-z)
  • [L5] Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data. [80] (10.1016/j.jhsg.2024.06.013)
  • [L3] Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union. [83] (10.1177/15589447221142894)
  • [L4] Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture. [84] (10.1007/s00256-014-1981-8)
  • [L4] Scaphoid nonunions demonstrate findings indicative of progression to union on CT at a mean of 6 weeks and as early as 3 weeks postoperatively. [86] (10.1016/j.jhsa.2016.07.051)

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