Scaphoid Fractures

A scaphoid fracture is a break in a small bone on the thumb side of your wrist. Of the eight carpal bones in your wrist, your scaphoid (also called navicular) bone is the most likely one to break.

It’s important to find out if you have a scaphoid fracture, because these need treatment to heal well. With proper treatment and follow-up, most scaphoid fractures will heal over time. Without treatment, and sometimes with treatment, healing can be slow and difficult because parts of the scaphoid bone don’t have a good blood supply. If your scaphoid bone does not heal well, you can develop long-term pain, stiffness or arthritis in your wrist.

Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while a person is playing sports, such as football, soccer or basketball or during activities, such as in-line skating, skateboarding or bike riding. They can also occur as a result of a car crash or fistfight.

Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:

• Pain, tenderness or swelling on the thumb side of your wrist
• Difficulty grasping or gripping things, or difficulty moving and twisting your wrist or thumb
• Bruises around your wrist

It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you fell on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Scaphoid fractures that are not treated properly can lead to long-term problems.

Your doctor will ask you questions about your symptoms and how and when you hurt your wrist. They will look at your wrist, find any swollen or tender areas, and see how well you can move your wrist and thumb. Your doctor will also try to determine how well blood is flowing to your hand and if you have any nerve damage in your wrist.

Your doctor will likely order X-rays of your wrist. Sometimes an X-ray clearly shows a scaphoid fracture, but other times that might not be apparent on an X-ray. If your doctor isn’t sure if your wrist is broken, they may refer you to an orthopedist, or a doctor who specializes in bone problems.  

Because fractures can’t always be seen right away, you may need a follow-up X-ray in one to two weeks. In the meantime, to prevent possible long-term problems, your doctor will treat you as though you do have a fracture. In some cases, other imaging tests, such as MRIs, CT scans and bone scans, are used to look for scaphoid fractures.

Treatment for scaphoid fractures includes wearing an arm cast or splint. Surgery is also a possible treatment. Right after the injury, you may wear a splint if your wrist is too swollen for a cast. You may also wear a splint if it is not clear whether your bone is broken. 

For the first few days, your doctor may tell you to elevate your wrist higher than the level of your heart and use cold packs or ice to reduce swelling. They may also prescribe pain medicine or suggest pain medicine you can buy without a prescription, such as acetaminophen or ibuprofen. Be safe with medicines. Read and follow all instructions on the label.

In some cases, after the swelling is gone, the splint will be removed and a cast will be put on. The cast will enclose your thumb and may extend above your elbow. Some people only need to wear a cast for six weeks, while others may have to wear one for several months. How long your wrist takes to heal depends on the severity of your fracture. Regular doctor visits will help you know how well your fracture is healing and learn how to care for your splint or cast.

In other cases, you may need surgery to put pieces of your bone in the proper place or help your bone heal faster. You may also need surgery if part of your bone died because it did not get enough blood (osteonecrosis). If you have surgery, you will need to wear a splint or cast afterward. Following surgery, once your splint or cast is removed, your arm or wrist may feel weak or stiff. Your doctor or a physical therapist can teach you exercises to strengthen your arm and wrist.