Scaphoid Fracture: X-ray, Symptoms & Healing Time
A scaphoid fracture is a break of the small wrist bone below the thumb, often missed on the first X-ray. See one on X-ray beside a labeled illustration.
A scaphoid fracture is a break of the scaphoid, the boat-shaped bone in the first row of the wrist on the thumb side. It is the most commonly fractured carpal bone and one of the most commonly missed fractures, because the break can be almost invisible on the first X-ray. The figure above shows a real X-ray of a scaphoid fracture with a medical illustration drawn from it: drag the slider to compare them.
The scaphoid
The scaphoid links the two rows of carpal bones, which is why it takes so much force when you fall on an outstretched hand. It has three parts:
- Distal pole: the end near the thumb, where the scaphoid tubercle can be felt on the palm side.
- Waist: the narrow middle.
- Proximal pole: the end that sits against the radius.
Most of its blood supply enters at the distal end and flows backward, so a fracture through the waist or proximal pole can cut off the blood to the proximal piece. For the full anatomy of the wrist, see hand and wrist anatomy.
Scaphoid fracture on X-ray
A standard wrist series is taken plus a dedicated scaphoid view, with the wrist bent toward the little finger so the scaphoid lies flat. On the X-ray above, a thin fracture line crosses the waist of the scaphoid, splitting it into a distal and a proximal pole that have not moved apart. This is a non-displaced waist fracture, the most common type.
| Finding | Why it matters |
|---|---|
| Location (distal pole, waist or proximal pole) | Proximal fractures heal more slowly and have a higher risk of nonunion |
| Displacement of more than 1 mm | Usually means surgery |
| Angulation or a step in the bone | Signals an unstable fracture |
| Normal first X-ray with snuffbox tenderness | Treated as a fracture until MRI, CT or repeat X-rays rule it out |
When the X-ray is normal but the wrist is still painful, MRI is the most sensitive test and can find the fracture within days. CT shows the fracture line and any displacement in detail and is used to check healing.
How a scaphoid fracture happens
Almost all scaphoid fractures come from a fall on an outstretched hand with the wrist bent back. They are most common in young adults, in sports, falls from bicycles and skateboards, and car crashes where the hands brace against the steering wheel. Older adults more often break the distal radius in the same kind of fall.
Symptoms
- Pain on the thumb side of the wrist, worse with gripping or pinching
- Tenderness in the anatomical snuffbox, the hollow at the base of the thumb
- Mild swelling, often with no visible deformity
- Pain when the thumb is pushed in toward the wrist
Treatment
- Thumb spica cast or splint: for non-displaced waist and distal pole fractures. The cast includes the thumb and is usually worn for 6 to 12 weeks.
- Screw fixation: a single headless compression screw placed through a small incision, for displaced fractures, proximal pole fractures and some non-displaced fractures in people who want to return to work or sport sooner.
- Bone graft and fixation: for fractures that have not healed (nonunion).
Recovery time
Waist fractures treated in a cast usually heal in about 6 to 12 weeks; proximal pole fractures can take 12 weeks or more. Healing is checked on X-ray or CT before the cast comes off, followed by hand therapy for stiffness and grip strength. After screw fixation, many people start gentle movement within a few weeks.
Complications
- Nonunion: the fracture does not heal, more common with proximal fractures, displacement, smoking and delayed treatment
- Avascular necrosis: the proximal pole loses its blood supply and dies
- SNAC wrist: progressive arthritis years after an untreated nonunion
- Stiffness and weakness of grip
How a scaphoid fracture is shown in a personal injury and malpractice case
Scaphoid fractures are a classic missed-fracture claim: a wrist X-ray read as normal after a fall, no splint, and a nonunion or avascular necrosis found months later. In a fall or vehicle case, the question is often whether the fracture was there from the start. An illustration drawn from the patient's own imaging, like the one above, shows where the fracture runs, why the proximal pole is at risk, and how a missed fracture progresses to collapse and arthritis. For how these images are used at trial, see demonstrative evidence and medical legal illustration.
Related pages
- Hand and wrist anatomyThe normal bones, joints and soft tissues of the hand and wrist.
- Boxer's fractureA boxer's fracture is a break of the fifth metacarpal neck, just below the little finger knuckle. See one on X-ray beside a labeled illustration.
- Colles fractureA Colles fracture is a break of the distal radius with the end tilted toward the back of the hand.
FAQ
What are the symptoms of a scaphoid fracture?+
Pain and swelling on the thumb side of the wrist after a fall on an outstretched hand, with tenderness in the anatomical snuffbox, the small hollow at the base of the thumb. Gripping, pinching and bending the wrist back hurt. There is often no visible deformity, so many people assume it is a sprain.
Why is a scaphoid fracture often missed?+
The fracture line is thin and the scaphoid sits at an angle, so up to about one in five scaphoid fractures do not show on the first X-rays. For that reason a painful wrist with snuffbox tenderness is usually splinted as if it were fractured, and then imaged again with repeat X-rays, MRI or CT.
How long does a broken scaphoid take to heal?+
A non-displaced fracture of the waist usually heals in a cast in about 6 to 12 weeks. Fractures of the proximal pole heal more slowly, often 12 weeks or more, because their blood supply is poor. Healing is confirmed on X-ray or CT before the cast comes off.
Does a scaphoid fracture need a cast or surgery?+
A non-displaced waist fracture is often treated in a cast. Surgery with a single compression screw is usually recommended for displaced fractures, proximal pole fractures, and fractures that have not healed, and it is offered to some people with non-displaced fractures to get them out of a cast sooner.
What happens if a scaphoid fracture is not treated?+
An untreated scaphoid fracture can fail to heal (nonunion) or the proximal pole can lose its blood supply and die (avascular necrosis). Over years this leads to wrist arthritis in a pattern called scaphoid nonunion advanced collapse (SNAC wrist).
Can you move your wrist with a broken scaphoid?+
Often yes, and that is part of why it is missed. Wrist and finger movement may be fairly normal apart from pain at the base of the thumb. Movement does not rule out a fracture.
What is a scaphoid waist fracture?+
The scaphoid has a distal pole near the thumb, a narrow middle called the waist, and a proximal pole next to the radius. About two thirds of scaphoid fractures cross the waist, like the one on this page.
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