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# Scaphoid fracture

A scaphoid fracture is a break of the wrist bone at the base of the thumb, usually from a fall on the hand; first X-rays can miss it and it may heal poorly.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Scaphoid](https://durgical.com/en/anatomy/scaphoid/)
- [Radial artery](https://durgical.com/en/anatomy/radial-artery/)
- [Radius](https://durgical.com/en/anatomy/radius/)
- [Lunate](https://durgical.com/en/anatomy/lunate/)
- [Scapholunate ligament](https://durgical.com/en/anatomy/scapholunate-interosseous-ligament/)
- [APL and EPB tendons](https://durgical.com/en/anatomy/abductor-pollicis-longus-and-extensor-pollicis-brevis-tendons/)
- [EPL](https://durgical.com/en/anatomy/extensor-pollicis-longus/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

Fracture of the scaphoid, the most commonly fractured carpal bone, usually from a fall on the outstretched hand. It is easily missed because first X-rays can be normal, and its fragile blood supply makes nonunion and avascular necrosis a risk.

## Who gets it

Typical of young, active adults, often men, after falls in sport, work or traffic accidents, including motorcycle accidents; less common in children and older adults, who more often break the distal [radius](https://durgical.com/en/anatomy/radius/).

## Causes

- Fall on an outstretched hand with the wrist extended and radially deviated
- Direct blow to the wrist
- Sports and motor vehicle or motorcycle accidents

## Risk factors

- Young, active adults
- Contact and high-energy sports
- Motorcycle riding
- Occupations with a risk of falls

## Pathophysiology

The scaphoid bridges the proximal and distal carpal rows, so forced wrist extension concentrates stress on its waist. Most of its blood enters distally from branches of the [radial artery](https://durgical.com/en/anatomy/radial-artery/) and flows retrograde to the proximal pole. A fracture can cut off that flow, so proximal fragments are prone to avascular necrosis and delayed or failed union.

## Classification

- By location: distal pole (including tubercle), waist (most common) or proximal pole (highest risk)
- Stable (non-displaced) or unstable (displaced, comminuted, angulated)
- Acute or established nonunion

## Symptoms and signs

- Pain on the radial side of the wrist after a fall
- Tenderness in the anatomical snuffbox
- Tenderness over the scaphoid tubercle on the palmar side
- Pain on axial compression of the thumb
- Mild swelling and reduced grip strength; deformity is uncommon

## Red flags

- Snuffbox tenderness with normal X-rays: treat as a possible fracture until excluded
- Numbness in the [median nerve](https://durgical.com/en/anatomy/median-nerve/) area: consider associated carpal dislocation
- Marked swelling or deformity: consider perilunate injury or distal radius fracture

## Diagnosis

**Clinical**
Snuffbox tenderness, [scaphoid](https://durgical.com/en/anatomy/scaphoid/) tubercle tenderness and pain on thumb axial compression after a fall; together they raise suspicion, but none is specific alone.

**Tests**
No laboratory tests are needed for diagnosis.

**Imaging**
Dedicated scaphoid X-ray views, which may be normal at first. If suspicion persists, the wrist is immobilised and MRI (most sensitive) or CT is done, or X-rays are repeated after 10 to 14 days.

## Differential diagnosis

- Distal radius fracture
- [Scapholunate ligament](https://durgical.com/en/anatomy/scapholunate-interosseous-ligament/) injury
- Wrist sprain
- De Quervain tenosynovitis
- Thumb base (first metacarpal) fracture

## Goal of treatment

Achieve bony union with good alignment, prevent nonunion and avascular necrosis, and restore pain-free wrist function.

## Treatment

**Conservative**
Cast or splint immobilisation including the thumb for non-displaced waist and distal pole fractures, with serial X-rays to confirm healing.

**Surgical**
Internal fixation with a headless compression screw (percutaneous or open) for displaced, unstable or proximal pole fractures, and in some active patients to return to work faster.

**Surgical**
For established nonunion: debridement, bone grafting (sometimes vascularised) and fixation.

**Rehabilitation**
Hand therapy after immobilisation to regain motion and grip strength.

## Complications

- Nonunion
- Avascular necrosis of the proximal pole
- Malunion with humpback deformity
- Scaphoid nonunion advanced collapse (SNAC) and wrist osteoarthritis
- Stiffness after prolonged immobilisation

## Prognosis

Most non-displaced fractures that are diagnosed and immobilised early heal well. Proximal pole and displaced fractures, and those diagnosed late, have higher rates of nonunion and avascular necrosis.

## Prevention

- Wrist guards in sports with frequent falls (skating, snowboarding)
- Protective gear and road safety for motorcycle riders

## Test yourself

Think of the answer, then tap the question to see it.

## Which clinical sign is classically associated with a scaphoid fracture?

Tenderness in the anatomical snuffbox, on the radial side of the wrist.

## Why is the proximal pole of the scaphoid at risk of avascular necrosis?

Blood from radial artery branches enters distally and flows retrograde to the proximal pole, so a fracture can cut off its supply.

## How is a suspected scaphoid fracture with normal initial X-rays managed?

Immobilisation and further imaging: MRI or CT, or repeat X-rays after 10 to 14 days.

## Which part of the scaphoid is most commonly fractured?

The waist (middle third).

## What late wrist problem follows untreated scaphoid nonunion?

Scaphoid nonunion advanced collapse (SNAC) with progressive wrist arthritis.

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## Related conditions

- [Distal radius fracture (Colles)](https://durgical.com/en/conditions/distal-radius-fracture/)
- [De Quervain tenosynovitis](https://durgical.com/en/conditions/de-quervain-tenosynovitis/)
- [Boxer fracture (fifth metacarpal neck)](https://durgical.com/en/conditions/boxer-fracture/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Scaphoid Wrist Fracture](https://www.ncbi.nlm.nih.gov/books/NBK536907/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/scaphoid-fracture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/scaphoid-fracture/