Scaphoid fracture

The scaphoid is the most commonly fractured carpal bone, typically from a fall on an outstretched hand. It is notorious for two problems: first, it is frequently missed on initial X-rays because early fractures are often invisible; second, the blood supply to the proximal pole is tenuous and retrograde, making the proximal pole — the most common site of high-energy fractures — prone to avascular necrosis if healing is delayed or inadequate.

Classic presentation is anatomic snuffbox tenderness (the hollow between the thumb tendons on the dorsoradial wrist) after a FOOSH injury.

Initial X-rays may be negative. Early MRI is the most sensitive test for acute scaphoid fracture and has replaced bone scan at most centers. CT is the best test for assessing fracture displacement, waist vs. proximal pole location, and — in delayed presentations — evaluating for avascular necrosis or nonunion.

Displaced fractures (>1 mm), proximal pole fractures, athletes seeking faster return to sport, and any fracture nonunion are managed surgically.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Hand (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language