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What is a scaphoid fracture?
Scaphoid fractures are a type of broken wrist. They happen when you break your scaphoid bone — a small bone near the base of your thumb. Your scaphoid is one of your carpal bones, the collection of bones that makes up your wrist.
Scaphoid fractures are almost always caused by catching yourself with outstretched arms after a fall. Car accidents and other traumas can also cause them. You might need surgery to repair your bone. Most people need around three months to recover from a scaphoid fracture.
Distal scaphoid fracture vs. proximal scaphoid fracture
Your scaphoid has three parts, all three of which can be broken. Sections of your scaphoid include:
- Distal pole: The end of your scaphoid closest to your hand and fingers (pointing away from your forearm).
- Waist of the scaphoid: The middle part of your scaphoid. More than 70% of scaphoid fractures occur in the waist.
- Proximal pole: The end of your scaphoid closest to your forearm (pointing in toward your body).
These different terms tell your healthcare provider specific details about how your wrist is broken, where your scaphoid broke and what the bone looks like inside of your body right now.
No matter which names and terms are applied to your fracture, the most important first step is getting your injury examined by your healthcare provider as soon as possible.
How common are scaphoid fractures?
Scaphoid fractures are the most common carpal bone fracture and make up 15% of wrist injuries.
Who gets scaphoid fractures?
Scaphoid fractures — like all bone fractures— can affect anyone. This is especially true because they’re caused by falls or other accidents. Scaphoid fractures are most common in teens and young adults under 30. If you’re at risk for falls, you might be more likely to experience a scaphoid fracture. People with osteoporosis have an increased risk for all types of broken bone, including scaphoid fractures.
Symptoms and Causes
What are the symptoms of a scaphoid fracture?
Symptoms of a scaphoid fracture include:
- Inability to move your wrist.
- Bruising or discoloration.
- A deformity or bump that’s not usually on your wrist.
Displaced scaphoid fractures
Displaced or non-displaced are more terms your healthcare provider will use to describe your fracture. A displaced fracture means the pieces of your bone moved so much that a gap formed around the fracture when your bone broke. Non-displaced fractures are still broken bones, but the pieces weren’t moved far enough to be out of alignment during the break. Displaced fractures are much more likely to require surgery to repair.
What causes scaphoid fractures?
Any impact to your wrist can cause scaphoid fractures. The most common causes include:
- Falls: Catching yourself with outstretched arms.
- Sports injuries.
- Car accidents.
Diagnosis and Tests
How are scaphoid fractures diagnosed?
Your healthcare provider will diagnose a scaphoid fracture with a physical exam and imaging tests.
What tests are done to diagnose a scaphoid fracture?
After a physical exam, you’ll likely need at least one of a few imaging tests:
- X-rays: An X-ray will confirm any scaphoid or other fractures and show how damaged your bones are.
- Magnetic resonance imaging (MRI): Your healthcare provider might use an MRI to get a complete picture of the damage to your bones and the area around them. This’ll show them tissue around your bones, too. This is especially important to determine if your muscles and connective tissue were injured.
- CT scan: If you need surgery, your healthcare provider or surgeon needs to know exactly how damaged your bones are. A CT scan will give them a more detailed picture of your bones and the surrounding tissue than an X-ray.
Occult scaphoid fractures
Scaphoid fractures sometimes don’t show up well (or at all) on X-rays. These are called occult scaphoid fractures. Your healthcare provider might need you to get an MRI or CT scan in addition to X-rays. Your healthcare provider will let you know what other imaging tests you’ll need.
Make sure you tell your healthcare provider exactly where you’re feeling any pain or tenderness. If your discomfort is centered right above your scaphoid and doesn’t get better after a day or two, you may have an occult scaphoid fracture. Occult fractures don’t need any different treatment or have any risks.
Management and Treatment
How are scaphoid fractures treated?
How your scaphoid fracture is treated depends on the severity of the original break. Your broken bone needs to heal back together. Depending on how damaged it is or what caused the break, there are a few treatments your healthcare provider might use.
If your break is mild and your scaphoid didn’t move far out of place (if it’s non-displaced), you might only need a splint or cast. Splinting usually lasts for three to five weeks. If you need a cast, it’ll likely be for longer, typically six to eight weeks. In both cases, you’ll likely need follow-up X-rays to make sure your bone is healing correctly.
More severe breaks require a closed reduction to set (realign) your scaphoid. During this nonsurgical procedure, your healthcare provider will physically push and pull your body on the outside to line up your broken bone on the inside. To prevent you from feeling pain during the procedure, you’ll receive one of the following:
- Local anesthetic to numb the area around your fracture.
- Sedatives to relax your whole body.
- General anesthesia to make you sleep through the procedure.
After the closed reduction, your healthcare provider will put you in a splint or cast.
Scaphoid fracture surgery
The most intense fractures require surgery. Your surgeon will realign (set) your scaphoid to its correct position and then secure it in place so it can heal and grow back together. They usually perform what’s called an internal fixation, which means your surgeon inserts pieces of metal into your bone to hold it in place while it heals. Internal fixation techniques include:
- Plates and screws: Metal plates screwed into your bone to hold the pieces together in place.
- Pins and wires: Pins and wires hold pieces of bone in place that are too small for other fasteners. They’ll typically be used at the same time as either rods or plates.
Some people live with these pieces inserted in them forever. You might need follow-up surgeries to remove them.
You might need bone grafting if your scaphoid fracture is severely displaced or if your bone isn’t healing back together as well as it should. Your surgeon will insert additional bone tissue to rejoin your fractured bone. After that, they’ll usually perform an internal fixation to hold the pieces together while your bone regrows. Bone grafts can come from a few sources:
- Internally from somewhere else in your body — usually the top of your hip bone.
- An external donor.
- An artificial replacement piece.
Scaphoid fracture surgeries are usually outpatient procedures, and you should be able to go home the same day.
After your surgery, your wrist will be immobilized. You’ll need a splint or cast before you can start using it as you did before your fracture.
What medications are used to treat scaphoid fractures?
Over-the-counter NSAIDs like aspirin or ibuprofen can lead to bleeding and other complications after surgery. Your surgeon will talk to you about the medications you can take to reduce pain after your surgery.
Side effects of NSAIDs include:
- Stomach pain.
- Bowel complications.
Can a scaphoid fracture heal on its own?
Never ignore symptoms like pain, swelling or tenderness. Even if your symptoms aren’t severe, you need treatment. If you have an untreated scaphoid fracture, you might face more serious complications later, including:
- Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage.
- Malunion: This happens when your broken bones don’t line up correctly while they heal.
- Nonunion: Your bones may not grow back together fully or at all.
- Avascular necrosis (osteonecrosis): This is a painful bone condition that gets worse over time and can affect your mobility. It occurs when something cuts off blood flow to one of your bones.
- Arthritis of the hand: Nonunion and avascular necrosis can lead to arthritis in your hand and wrist. Arthritis of the hand causes pain and swelling, stiffness and deformity.
How soon after treatment will I feel better?
It might take a few weeks for your symptoms to improve. Depending on which type of surgery you had to repair your scaphoid fracture, you should be able to start moving again in a few weeks.
If you experience intense pain that doesn’t get better, contact your healthcare provider right away.
How can I reduce my risk for scaphoid fractures?
Follow these general safety tips to reduce your risk of an injury:
- Always wear your seatbelt.
- Wear the right protective equipment for all activities and sports.
- Make sure your home and workspace are free from clutter that could trip you or others.
- Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
- Follow a diet and exercise plan that’ll help you maintain good bone health.
- Talk to your healthcare provider about a bone density test if you’re older than 50 or if you have a family history of osteoporosis.
- If you use a cane or walker to help walk, always use it and be careful on uneven surfaces.
How can I prevent a scaphoid fracture?
Scaphoid fractures are usually caused by falls or other accidents, so there’s not much you can do to prevent them other than safety precautions while walking (use your cane or walker if you have one) and being careful on uneven surfaces.
Outlook / Prognosis
What can I expect if I have a scaphoid fracture?
If you have a scaphoid fracture, you should expect to make a full recovery.
You’ll need physical therapy to regain strength and range of motion in your wrist.
How long does it take a scaphoid fracture to heal?
How long it takes you to heal depends on the severity of your fracture and which treatments you needed. Most people need around three months to recover from a scaphoid fracture.
There are lots of factors that can affect how long it takes your body to heal. Talk to your healthcare provider or surgeon about a timeline that fits your specific situation.
Will I need to miss work or school?
If you can do your job or schoolwork with your wrist immobilized, you shouldn’t need to miss work or school.
Talk to your surgeon or healthcare provider before resuming any physical activities while you’re recovering.
Outlook for a scaphoid fracture
The outlook for scaphoid fractures is positive. Even if you need surgery, you should make a full recovery and shouldn’t have any long-term effects from your fracture.
When should I go to the emergency room?
If you think you have a scaphoid fracture — or any other broken bone — you need to see a healthcare provider as soon as possible. Go to the emergency room if you experience any of the following:
- Intense pain.
- You can’t move a part of your body that you normally can.
- A part of your body is noticeably different looking or out of its usual place.
- You can see your bone through your skin.
- New bruising that appears at the same time as any of these other symptoms.
Go to the emergency room right away if you’ve experienced a trauma.
What questions should I ask my doctor?
- Do I have a scaphoid fracture or another type of break?
- Which part of my scaphoid is broken?
- Will I need surgery?
- How long will it take to recover?
- When can I resume physical activities?
A note from Cleveland Clinic
Breaking a bone is always scary, especially if it happens suddenly after you slip or fall. Scaphoid fractures respond well to treatment, and there are lots of options to make sure your bones and body heal properly. Talk to your healthcare provider about how you can keep your bones strong and healthy, and get regular bone density screenings if you’re older than 50 or have a family history of osteoporosis.
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