Scaphoid Fracture: Symptoms, Types, Causes and Treatment

The scaphoid bone, nestled in the wrist, is a small but crucial player in hand movement and stability. Its unique shape and blood supply make fractures both common and potentially troublesome. Early recognition and appropriate treatment are essential to prevent long-term complications such as nonunion, malunion, and wrist arthritis. In this article, we explore the symptoms, types, causes, and modern treatment options for scaphoid fractures, synthesizing the latest research and clinical guidelines.

Symptoms of Scaphoid Fracture

A scaphoid fracture can be deceptive. Its symptoms often mimic a simple wrist sprain, leading to misdiagnosis or delayed treatment. Recognizing the typical signs and knowing when to seek further evaluation can make a significant difference in recovery and long-term wrist function.

Symptom	Description	Clinical Relevance	Source(s)
Wrist Pain	Persistent pain in the wrist, especially on the thumb side	Most common initial complaint	1, 5, 7
Swelling	Swelling and tenderness over the "anatomical snuffbox"	Key diagnostic clue	1, 3, 5
Reduced Motion	Difficulty gripping or reduced wrist range of motion	Functional impact, may suggest fracture	1, 5
Pain on Pressure	Pain when pressing on the scaphoid tubercle or snuffbox	Clinical test for scaphoid injury	1, 5, 3

Table 1: Key Symptoms

Common Presentations

The most consistent symptom of a scaphoid fracture is pain on the thumb side of the wrist, especially after a fall. This pain is often accompanied by moderate swelling and tenderness in the anatomical snuffbox—the hollow at the base of the thumb when you extend it 1, 5.

Diagnostic Clues

• Anatomical Snuffbox Tenderness: Pressing here reproduces pain in most scaphoid fractures.
• Pain on Axial Thumb Loading: Pushing down on the thumb may elicit pain.
• Reduced Grip Strength: Many patients notice weakness when grasping objects.
• Limited Wrist Movement: Especially in extension (bending the hand backward).

When to Suspect a Scaphoid Fracture

Scaphoid fractures are easily mistaken for wrist sprains, especially if X-rays are initially normal 1, 3. However, persistent pain and tenderness—even without visible swelling—warrant further imaging and possibly advanced scans (MRI or CT) if suspicion remains high 4.

Types of Scaphoid Fracture

Scaphoid fractures are not all the same. They vary by location, displacement, and even the patient’s age. Each type has its own prognosis and recommended treatment.

Type	Location/Feature	Typical Patient	Source(s)
Waist Fracture	Middle third of scaphoid	Young adults (majority of cases)	5, 6, 8
Proximal Pole	Closest to forearm	More severe, worse prognosis	3, 4, 5
Distal Pole	Closer to thumb	More common in children	2, 4, 6
Tubercle	Small bony prominence	Often avulsion type, in children	2, 6
Displaced	Fragments shifted >1 mm	Adults, higher risk of nonunion	3, 4, 5
Non-displaced	Minimal or no shift	Most common, better healing	4, 5, 8

Table 2: Scaphoid Fracture Types

Fracture Location

Waist Fractures

• Most Common: About 60–70% of all scaphoid fractures occur at the waist (middle third of the bone) 5, 6, 8.
• Healing: Generally good blood supply, but risk of nonunion if displaced.

Proximal Pole Fractures

• Less Common but Severe: Occur near the forearm. Blood supply is tenuous, making healing slow and risk of avascular necrosis high 3, 4, 5.
• Often need surgical fixation.

Distal Pole and Tubercle Fractures

• More Frequent in Children: The distal third and tubercle fractures are common in pediatric patients, often as avulsion injuries 2, 4.
• Usually heal well with conservative treatment.

Displacement and Stability

• Non-displaced Fractures: No or minimal movement of bone fragments. These are the most common and have high healing rates with casting 4, 5, 8.
• Displaced Fractures: Fragments are shifted (especially >1 mm). These are more prone to nonunion and often require surgical intervention 3, 4, 5.

Special Types in Children

Children’s scaphoid fractures are rare and classified by age and ossification stage:

• Type 1: Pure chondral (cartilage) fracture in children <8 years. Very rare, detected by MRI/CT.
• Type 2: Osteochondral (bone and cartilage) in ages 8–11.
• Type 3: True bony fractures in those >12 years, most common in this group 2.

Causes of Scaphoid Fracture

Understanding the mechanisms and risk factors for scaphoid fracture can help with prevention and early recognition.

Cause	Mechanism/Context	At-risk Group	Source(s)
Fall on Outstretched Hand	Wrist in extension and radial deviation	Young adults, athletes	1, 5, 6
Direct Blow	Direct impact to wrist	Less common	1, 5
High-energy Trauma	Motor vehicle accidents, sports injuries	Males 15–35 years	6, 5
Avulsion Injury	Sudden force on ligament	Children (tubercle fracture)	2

Table 3: Major Causes

Typical Injury Mechanism

Fall on Outstretched Hand (FOOSH)

• Classic Scenario: Most scaphoid fractures happen when someone falls and lands on an outstretched hand, with the wrist bent back (extended) and the hand turned towards the thumb (radial deviation) 1, 5.
• Force Transmission: The scaphoid is caught between the radius and capitate bones, bearing most of the impact 1.

Demographics and Risk Factors

• Age: Most common in young adults, especially males aged 15–35 6.
• Activity: Sports, cycling, skateboarding, and contact activities increase risk.
• Socioeconomic Status: Higher incidence in individuals from lower socioeconomic backgrounds, possibly due to higher exposure to physical activities or occupational risks 6.
• Seasonality: Slightly higher rates in summer months, possibly related to increased outdoor activity 6.

Less Common Mechanisms

• Direct Blow: A direct impact to the wrist can occasionally cause a scaphoid break 1, 5.
• Avulsion Injuries in Children: Sudden forceful pull on ligaments attached to the tubercle can cause avulsion fractures, most often in kids 2.

Treatment of Scaphoid Fracture

Treatment strategies for scaphoid fractures have evolved significantly. The choice between conservative and surgical options depends on fracture type, location, displacement, and patient factors. The ultimate goals: achieve bone union, restore function, and prevent complications.

Treatment	Indication/Type	Expected Outcome	Source(s)
Cast Immobilization	Non-displaced, distal pole, children	High union rates, 4–10 weeks immobilization	4, 5, 8
Surgical Fixation	Displaced (>1 mm), proximal pole, nonunions	Faster healing, lower nonunion risk	3, 4, 5, 7
Percutaneous Fixation	Minimally displaced, select acute fractures	Minimally invasive, quick recovery	5, 9
Bone Grafting	Nonunion, avascular necrosis	Promotes healing, corrects deformity	7, 5

Table 4: Treatment Options

Conservative Management

Cast Immobilization

• Indication: Non-displaced or minimally displaced waist fractures, distal pole fractures, most pediatric cases 4, 5, 8.
• Duration:
  • Waist: ~6 weeks for non-displaced, 8–10 weeks if mildly displaced.
  • Distal: 4–6 weeks.
• Success Rate: Up to 90% union in non-displaced fractures 4, 8.
• Drawbacks: Prolonged casting can lead to muscle atrophy, joint stiffness, and financial burden due to time off work 5.

Evidence from SWIFFT Trial

• Large clinical trial showed no significant difference in wrist function at 1 year between early surgical fixation and initial casting for waist fractures displaced ≤2 mm. Most patients should start with casting, reserving surgery for nonunions 8.

Surgical Management

Internal Fixation

• Indication: Displaced (≥1.5 mm) waist fractures, proximal pole fractures, nonunions, select unstable or high-demand cases 3, 4, 5, 7.
• Techniques: Open or percutaneous screw fixation; percutaneous approaches are minimally invasive and reduce complications 5, 9.
• Advantages: May allow earlier mobilization, lower risk of nonunion in selected patients 5, 9.

Advances in Surgery

• Percutaneous and Arthroscopic Fixation: Minimally invasive, rapid recovery, nearly 100% union rates in selected cases 9.
• Vascularized Bone Grafts: Used for difficult nonunions, especially with avascular necrosis, to promote healing 5, 7.

Management of Nonunion and Complications

• Nonunion: Occurs in up to 15% of cases. Surgical intervention with bone grafting and fixation is standard 3, 7.
• Avascular Necrosis: Requires vascularized bone grafts.
• Malunion or Humpback Deformity: Correction via surgery to restore wrist mechanics and prevent arthritis 7.

Conclusion

Scaphoid fractures, though sometimes subtle in presentation, demand careful attention to diagnosis and treatment. Their unique anatomy and blood supply pose risks for healing complications, but modern management strategies offer excellent outcomes when tailored to fracture type and patient needs.

Key Takeaways:

• Scaphoid fractures are the most common carpal bone fractures, especially in young, active adults 1, 5, 6.
• Symptoms include wrist pain, snuffbox tenderness, and reduced grip or motion—often after a fall on an outstretched hand 1, 5.
• Fracture type (waist, proximal, distal, displaced, non-displaced) determines prognosis and treatment strategy 3, 4, 5, 6.
• Initial management for most non-displaced fractures is cast immobilization, while displaced and proximal fractures often require surgery 4, 5, 7, 8.
• Advances such as percutaneous fixation and vascularized bone grafting improve outcomes for complex cases 5, 7, 9.
• Prompt diagnosis and appropriate intervention are vital to prevent nonunion, malunion, and long-term wrist dysfunction 1, 3, 7.

By understanding the symptoms, types, causes, and treatments of scaphoid fractures, patients and clinicians can work together for optimal recovery and long-term wrist health.