What is a scaphoid fracture?

The scaphoid is a small bone in the wrist, roughly the size and shape of a cashew nut. It sits at the base of the thumb on the back of the wrist, between the radius and the rest of the carpal bones. It plays a crucial role in linking the two rows of carpal bones, and a fracture that fails to heal can lead to a predictable pattern of wrist arthritis over many years (SNAC wrist).

Scaphoid fractures are difficult to diagnose. The pain after a fall onto the outstretched hand can be relatively mild and easily mistaken for a "sprain". Plain X-rays are insensitive in the first two weeks, the fracture line is often invisible until early bone resorption occurs. Tenderness in the "anatomical snuffbox" (the small dip on the back of the wrist at the base of the thumb) is the key clinical sign.

The blood supply to the scaphoid enters from one end of the bone, so the upper (proximal) half relies on blood travelling through the bone itself. A fracture across the bone can cut off the blood supply to the proximal fragment, leading to non-union or avascular necrosis. The further from the wrist the fracture is, the better it heals; the closer to the wrist (proximal pole), the higher the non-union rate.

Common causes

Fall onto an outstretched hand, the dominant cause
Sporting injury, particularly cycling, skiing, skateboarding, contact sport
Direct blow to the wrist
Road traffic collision (motorcycle)
Punching injury (occasionally)

Who is at risk? Young men aged 15-30 are most commonly affected. High-impact sports, motorcycling, and recreational falls all increase risk. Smoking significantly increases the non-union rate.

Symptoms

Symptoms vary depending on the severity and duration of the condition. Common symptoms include:

Pain on the thumb side of the wrist after a fall
Tenderness in the anatomical snuffbox
Tenderness over the scaphoid tubercle on the palm side of the wrist
Pain on axial compression of the thumb
Swelling around the wrist
Reduced wrist movement and grip strength

When to seek help: Any wrist injury with tenderness on the thumb side of the wrist needs urgent assessment in an Emergency Department for X-ray. A "wrist sprain" that does not improve over 1-2 weeks should be re-imaged or referred, missing a scaphoid fracture can have lifelong consequences.

How is it diagnosed?

Your hand surgeon will take a detailed history and examine the hand and wrist. The following investigations may be arranged to confirm the diagnosis:

Plain X-rays, specific scaphoid views (PA in ulnar deviation)
Repeat imaging at 2 weeks if initial X-rays are negative but clinical suspicion remains
MRI, the gold standard for early diagnosis, often performed within days
CT scan, for assessing displacement and union after treatment
Bone scan, rarely used now

Up to 30% of acute scaphoid fractures are not visible on initial X-rays. If there is clinical suspicion (snuffbox tenderness, mechanism of injury), the wrist should be immobilised in a cast and re-assessed with repeat X-ray, MRI or CT within 1-2 weeks.

Treatment pathway

Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.

Undisplaced fracture

Cast immobilisation

Most undisplaced scaphoid fractures heal in a below-elbow cast worn for 6-12 weeks, depending on the fracture location. Healing is monitored with X-rays and sometimes CT. The hand is usable for very light activities; gripping and lifting are not permitted during cast treatment.

Surgical option

Percutaneous screw fixation

A small headless compression screw is inserted across the fracture through a small incision, under fluoroscopic guidance. Avoids prolonged casting, allows earlier return to activity, and is increasingly used for active patients and proximal pole fractures. Day case surgery.

For displaced or unstable fractures

Open reduction and internal fixation

For displaced fractures, comminuted fractures, or fractures associated with carpal ligament injury, open surgery with screw fixation is required. Bone grafting may be used for established non-union or proximal pole fractures with avascular necrosis.

Recovery

Recovery depends heavily on the location of the fracture. Distal (tubercle) fractures heal reliably in 6 weeks. Waist fractures take 8-12 weeks. Proximal pole fractures are slow to heal and have higher non-union rates. After surgical fixation patients can usually return to sport at 8-12 weeks.

Cast (waist fracture): 6-8 weeks
Cast (proximal pole): 10-12 weeks
After surgery, light activity: 2-4 weeks
Full return to sport: 3-6 months

What results can I expect?

Most undisplaced fractures heal well. Non-union rates are 5-15% overall, but rise to 30-40% for proximal pole fractures and in smokers. Untreated non-union leads to progressive wrist arthritis (SNAC wrist) over 10-20 years, which can be challenging to treat.

In numbers

Most

common carpal fracture[1]

accounts for the majority of carpal bone fractures

FOOSH

is the typical mechanism[1]

fall onto an outstretched hand with the wrist extended

May

be missed on X-ray[1]

an early scaphoid fracture is often invisible on the first X-ray, MRI or CT is used if clinically suspected

Months

to heal in a cast[1]

typical 8 to 12 weeks for cast treatment

What the evidence shows

The scaphoid has a precarious blood supply, blood enters from the distal end and travels back toward the proximal pole, fractures across the waist can cut off the blood supply[1]

Non-union (failure to heal) is a recognised risk, particularly with proximal pole fractures, displaced fractures, and delayed diagnosis[1]

Early surgical fixation may be offered for proximal pole or displaced fractures, and is increasingly considered for non-displaced waist fractures in active adults to allow earlier return to work and sport[1]

A clinically suspected scaphoid fracture with a normal X-ray is treated as a fracture until repeat imaging (MRI, CT, or follow-up X-ray) confirms or excludes it[2]

Untreated scaphoid non-union can lead to a specific pattern of wrist arthritis (SNAC wrist) years later[1]

When can I…?

Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and hand therapist.

Activity	Typical timeline	Notes
Move fingers and thumb tip	Day one	Even with a wrist cast, the fingers and thumb tip should move freely from day one.[3]
Drive	When cast is off	Driving in a scaphoid cast is generally not recommended. Most patients drive after cast removal at 8-12 weeks.[4]
Shower	Cast covered	A waterproof cast cover allows showering. Casts can be re-applied if they get wet.
Desk work	Days to weeks	Most patients return to desk-based work in a cast or splint within days.[1]
Manual work	After healing confirmed	Heavy work and impact loading wait until X-ray or CT confirms full bone healing, often 3-6 months.[1]
Sport	3-6 months	Non-impact sport earlier, contact and impact sport only once the fracture has fully healed.[1]
Lift heavy objects	After bone union	Confirmed bone healing on imaging is required before heavy loading, the scaphoid is at risk of non-union if loaded too early.[1]

Is this normal?

Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.

A normal early X-ray does not exclude a scaphoid fracture. Persistent pain in the anatomical snuffbox should be treated as a scaphoid fracture until repeat imaging (MRI, CT, or repeat X-ray at 10-14 days) confirms or rules it out.[2]

Some elbow and shoulder stiffness can develop when the wrist is immobilised. Daily movement of the elbow, shoulder, fingers, and thumb tip is important throughout cast treatment.[3]

It can be. Scaphoid healing is sometimes difficult to see on plain X-ray, and a CT or MRI scan may be needed to confirm. Delayed union is a recognised concern and your team will monitor this carefully.[1]

Yes, after weeks of immobilisation. Movement and strength return gradually with hand therapy. Most patients regain functional range within 3-6 months.[3]

This is worth investigating. Persistent pain after the expected healing time can indicate delayed union, non-union, or another wrist problem. CT or MRI may be advised. Contact your team.[1]

References & further reading

References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.

Scaphoid fracture