Scaphoid Fracture

The scaphoid (navicular) is one of the small “carpal bones” in the wrist. It is a commonly fractured bone, often from a fall. If left untreated, this could lead to progressive arthritis in the wrist known as “scaphoid nonunion advanced collapse” (SNAC).

Initial evaluation consists of an x-ray. Sometimes, the fracture is not immediately visible on x-rays at the time of the injury. In certain situations, additional imaging with a CT scan or MRI is needed to see the fracture and to determine the appropriate treatment. If there is treatment in the wrist at the “anatomic snuffbox”, then sometimes a splint is worn until repeat x-rays can be taken at 1-2 weeks after the injury.

Both the location of the fracture within the scaphoid and the degree of “displacement”, which is the amount that the bone has shifted, are important for determining the appropriate treatment. In some situations, particularly when the scaphoid fracture is “non-displaced”, immobilization with a cast is necessary. In other situations, surgery is needed. This often is done through a small incision and placement of a buried headless compression screw within the bone.

In certain situations, particularly when the scaphoid has not healed and has gone onto a non-union or when the “proximal pole” of the scaphoid is too small to fix or has progressed to “avascular necrosis”, more advanced reconstruction may be necessary. This may include the use of a “vascularized bone graft” or “bone flap” from the knee, which may include a medial femoral condyle (MFC) or medial femoral trochlea (MFT) flap.

If treated non-operatively, often a cast is necessary for 6-12 weeks depending on the location of the fracture.

If treated operatively, sometimes motion can begin as soon as 2 weeks post-operatively for simpler fractures. A cast may be necessary for longer periods for more complex fractures.

Full use of the hand and the wrist with full weightbearing often begins 3 months after the injury.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with scaphoid fractures from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons