Scaphoid Fracture and Nonunion

What it is

The scaphoid is one of the eight small wrist bones. It bridges the two rows of wrist bones, which puts it at extra risk of breaking. It has a delicate blood supply, so fractures can be slow to heal.

Symptoms

Pain and swelling on the thumb side of the wrist after a fall onto an outstretched hand. Because the wrist usually looks normal and still moves, many people assume it is a sprain. Delaying treatment can cause problems, so see a surgeon if you may have broken your wrist.

Diagnosis

X-rays usually show the fracture, but not always. If you are tender in the hollow on the thumb side of the wrist, a splint may be recommended to be safe, with repeat X-rays in one to two weeks. A CT scan or MRI can clarify the diagnosis or help plan surgery.

Treatment

Cast: fractures that have not shifted often heal in a cast, sometimes in as little as six weeks, though some take longer.

Surgery: displaced fractures, or those in certain parts of the bone, may be fixed with a screw or pins.

Scaphoid nonunion

A scaphoid fracture that fails to heal is called a nonunion. It may cause few symptoms, or weakness such as trouble doing push-ups. Without treatment, it can lead to wrist arthritis. Treatment usually involves surgery to clean out the fracture, add bone graft, and fix it with a screw or pins. Smoking makes healing less likely.