Many scaphoid fractures heal in a cast, but displaced or unstable fractures usually require surgery with a small headless compression screw. Surgery may also be considered for non-displaced fractures in patients who need to avoid prolonged casting.
Surgery is usually arranged within 1-2 weeks of injury. Pre-assessment may take place at the same visit as your fracture clinic review.
The team will confirm you are fit for anaesthesia and explain the procedure in detail.
Routine pre-operative checks; baseline blood pressure, pulse, and (if needed) bloods.
Blood thinners may need adjustment. Otherwise most medications continue as normal.
Options include regional nerve block (brachial plexus block) with sedation, or general anaesthesia.
Your surgeon may request additional imaging (CT or MRI) before surgery to plan screw placement accurately.
Smoking significantly increases the risk of non-union for scaphoid fractures, which already have a precarious blood supply. Stopping is strongly recommended.
You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am, unless your team gives you different instructions. Bring your medication list and any documents from the hospital.
You will be admitted to the day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist. Many hand procedures are done under local or regional anaesthetic; some require general anaesthesia.
After surgery you will spend time in the recovery area where nurses monitor your vital signs until you are stable and comfortable.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Important: Scaphoid fractures have a particular risk of non-union (failure to heal) due to their blood supply. Persistent pain in the snuffbox area, especially with use, should be reported - further imaging may be needed even after the initial recovery period.
Avoid getting the wound wet until it is fully healed - usually 10-14 days. Use a waterproof cover when showering. Follow the dressing instructions you are given.
Keep the hand raised above the level of your heart as much as possible for the first 48-72 hours. This significantly reduces swelling, pain, and stiffness.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, and ibuprofen if appropriate for you) is more effective than waiting.
Unless told otherwise, gently bend and straighten all fingers regularly. Early movement helps prevent stiffness and reduces swelling.
Seek urgent advice if you develop spreading redness, increasing pain, swelling, discharge from the wound, a temperature above 38°C, or any new numbness - these may indicate infection or nerve problems.
Recovery timelines vary between patients and depend on the operation, the demands you place on the hand, and any other health conditions. The timeline below is a general guide - your surgical and hand therapy team will give you personal advice.
A small incision is made and a compression screw passed through the scaphoid. The procedure takes 45-90 minutes.
Most patients go home the same day in a splint.
A removable splint is worn for 4-6 weeks. Finger movement and shoulder mobility are encouraged.
Once imaging confirms healing, the splint is weaned and active wrist movement progresses under hand therapy.
Most patients return to full activity by 3-6 months. Contact sport and heavy manual work may require longer protection.
The scaphoid has a precarious blood supply and a high rate of non-union if not adequately stabilised. Surgical fixation gives reliable compression across the fracture and allows earlier movement.
A removable splint is most often used after screw fixation, allowing safer skin checks and gradual mobilisation. A cast may sometimes be used initially or if there are concerns about healing.
Non-contact sport may be possible at 3 months. Contact and high-impact sport typically resumes at 4-6 months, once imaging confirms full healing.
The compression screw is buried inside the bone and is usually left permanently. Removal is rarely required.
A week-by-week guide to recovery. Individual timelines vary, so always follow the advice of your surgical and hand therapy team.
The aim of surgery is to hold the broken scaphoid bone securely with a small screw so that it heals reliably. Because the scaphoid has a poor blood supply and is slow to heal, fixation can improve the chance of union and, for selected fractures, allow an earlier return to activity than a long period in plaster.
The operation is done under regional or general anaesthetic. A specialised compression screw is placed across the fracture, either through a tiny incision under X-ray guidance (percutaneous) or through an open incision, depending on the fracture. For fractures that have not united, bone graft may be added to encourage healing.
Undisplaced scaphoid fractures often heal in a cast, but this can take six to twelve weeks or longer and requires the cast to be worn consistently.
Not advisable for a confirmed fracture. A scaphoid fracture that is missed or not allowed to heal can fail to unite (non-union), which over years can lead to wrist arthritis.
Because of the poor blood supply, the scaphoid can fail to unite, particularly fractures near the top (proximal pole). Non-union may need further surgery with bone graft.
Part of the bone can lose its blood supply and soften, which can affect healing and the long-term health of the wrist.
The screw can be slightly too long or out of position and occasionally needs adjusting or removing.
A scaphoid that does not unite can lead to a pattern of wrist arthritis over years (a SNAC wrist).
Usually a superficial wound infection that settles with antibiotics.
Some stiffness of the wrist is common and improves with hand therapy after healing.
The scar can be firm and tender for a few weeks and settles with time.
Grip strength is reduced for some weeks and recovers as the wrist heals and rehabilitates.
An undisplaced scaphoid fracture can heal in a plaster cast, but this often means six to twelve weeks or more in plaster, and healing must be confirmed on a scan. The main concern with not fixing a fracture is non-union: displaced fractures and those near the top of the bone are at higher risk of failing to heal, and an untreated non-union can lead to wrist arthritis over the years. Your surgeon will balance the type of fracture against the time in cast when advising you.