Scaphoid Fractures

The scaphoid is a small bone situated at the base of the thumb at the wrist joint. It frequently fractures after a fall onto the outstretched hand, often during sporting activities. Scaphoid fractures may produce very mild symptoms of pain and reduced movement - often felt for only a few weeks.

Scaphoid fractures can be difficult to diagnose. The patient is unlikely to complain of significant pain, and the x-rays are often interpreted as normal because the scaphoid lies in the shadow of other small wrist bones on the x-ray, and the fracture line cannot be seen. As a result, some people may not receive the appropriate treatment at an early stage and, on occasions, the scaphoid fracture fails to heal. In order to avoid this situation, people with wrist pain after a fall are often treated as if they have a scaphoid fracture, even if there is no proof on the x-ray. X-rays are repeated in the weeks after injury and, if they still appear normal (and the pain has settled), treatment will be stopped. Sometimes a special scan is required to make this decision.

When there is no doubt with the diagnosis, and it is clear that a scaphoid fracture has occurred, a plaster cast will be applied for a period of 6 or 8 weeks. 85% of scaphoid fractures will heal with this treatment. Some people cannot tolerate the plaster cast for such a period and will be offered an operation to place a small screw across the scaphoid fracture through a tiny incision (percutaneous fixation). There is no proof that this treatment improves the chances of healing of the fracture, but it may allow the wrist to regain its range of movement at an earlier stage than after treatment with a plaster cast.

Even after a scaphoid fracture has healed without difficulty, 50% of people will still experience some wrist pain for up to 2 years after the injury.