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Scaphoid (Wrist) Injuries

A woman slipping on ice and bracing her fall with her hands.

The scaphoid (also known as the carpal navicular) is one of the eight small bones of the wrist. This bone, shaped like a cashew or kidney bean, is located on the thumb side of the wrist. The eight small bones of the wrist are organized into two rows and the scaphoid serves an essential role coordinating the motion between these two rows of bones. A fracture is the most common type of scaphoid injury.

What is a scaphoid fracture?

A scaphoid fracture is a break in one or more places of the scaphoid bone in the wrist. The scaphoid is also associated with an important wrist ligament (scapholunate ligament), which can also tear in certain injuries, including fractures. Appropriate treatment of scaphoid injuries is critical to ensure healing and prevent wrist arthritis.

What causes scaphoid fractures?

Scaphoid fractures usually occur when a person falls onto an outstretched hand. This injury mechanism can occur during walking, running, or sports. Higher energy injuries can sometimes be associated with other fractures or soft tissue injuries in the wrist.

How do you know if your scaphoid is broken?

Scaphoid fractures present with wrist and/or thumb pain (with gripping, lifting, and motion), swelling and bruising. Since the scaphoid bone is relatively small, these presenting symptoms may be less dramatic than other types of wrist fractures (for example, a distal radius fracture) where visible deformity may be immediately visible. Furthermore, scaphoid fractures can sometimes be “occult” (meaning not visible) on X-rays immediately after injury. For this reason, advanced imaging studies (such as a CT scan or MRI) may be obtained to further evaluate for scaphoid fracture if X-rays are negative but scaphoid fracture is suspected.

Unfortunately, given the relatively mild presenting symptoms and sometimes subtle X-ray findings acutely, scaphoid fractures can go undiagnosed initially. An unhealed scaphoid fracture (called scaphoid nonunion) is a challenging problem which often requires surgery.

What kind of doctor should I see for a scaphoid fracture?

Depending on the severity of your initial injury, initial evaluation may require visiting an urgent care or emergency room. Otherwise, seeing a sports medicine specialist or orthopedist is ideal. Initial evaluation will include physical examination and X-rays (with specific views to best visualize the scaphoid). As mentioned previously, sometimes advanced imaging (such as CT or MRI) is needed if pain/tenderness is localized to the scaphoid, but X-rays are negative. (Find a doctor at HSS who treats scaphoid fractures.)

What is the treatment for a scaphoid fracture?

Scaphoid fracture treatment depends on multiple factors: patient age, fracture location, fracture pattern, and fracture displacement. The scaphoid has a tenuous blood supply. Blood supply is required for fracture healing. These variables correlate with the likelihood of fracture healing with nonoperative treatment. If amenable to nonsurgical treatment, a short-arm thumb spica cast is typically applied. If the chance of a fracture healing is unacceptably poor, surgery may be recommended. This typically consists of screw fixation through a small incision. Larger incisions and possibly bone grafts may be required for severely displaced fractures and/or scaphoid fractures which only become apparent on delayed basis (“scaphoid nonunion”).

What is the recovery time for a scaphoid fracture?

The average healing time for a scaphoid fracture varies widely depending on patient age and fracture location. Fractures closer to the thumb (called “distal pole” scaphoid fractures) heal fastest and usually do not require surgery. Fractures closer to the wrist (called “proximal pole” scaphoid fractures) heal slowest and almost always require surgery. Fractures in the middle (called scaphoid “waist” fractures) fall in the middle with regard to healing time and the chance of needing surgery.

What happens if a scaphoid fracture is left untreated?

A scaphoid fracture can lead to wrist osteoarthritis, especially if the fracture is untreated and/or does not heal correctly. This is called “nonunion.” A long-term effect of untreated nonunion – with incorrect alignment of wrist bones – can lead to a specific pattern of degenerative arthritis (osteoarthritis) known as scaphoid nonunion advanced collapse or “SNAC.” Learn more about SNAC in Scaphoid Fractures and Nonunion: Wrist Fractures and Treatment.

A rupture (tear) of the scapholunate ligament can accompany a scaphoid fracture or occur on its own. This ligament connects the scaphoid with its neighbor, the lunate bone (also known as the semilunar bone). If the scapholunate ligament tears and goes undetected and untreated, this can lead to carpal instability and, over time, osteoarthritis of the wrist. This can advance to become what is called scapholunate advanced collapse (SLAC wrist), in which there is arthritic deformity and instability. Learn more about SLAC wrist in Common Conditions of the Wrist: A Powerful, but Vulnerable Joint, and explore other related content below.

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Reviewed and updated by Samir K. Trehan, MD

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