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Scaphoid Fracture

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Other Names

  • Scaphoid non union
  • Occult scaphoid fracture


  • This page refers to fractures of the Scaphoid bone


  • Scaphoid is most commonly fractured carpal bone (need citation)
  • 10% of all hand fractures and 60% of all carpal fractures (need citation)
  • 15% of wrist fractures (need citation)
  • Males > females


Left palmer view of the scaphoid bone
Palpation of the (A) snuff box and (B) scaphoid tubercle[1]


  • Proximal 80% of scaphoid receives retrograde blood flow from dorsal carpal branch of the radial artery
  • Distal 20% receives blood supply from superficial palmar arch
  • Retrograde blood supply makes scaphoid particular susceptible to avascular necrosis and nonunion

Location (need citation)

  • 65% occur in the waist
  • 25% proximal 1/3rd
  • 10% distal 1/3rd


  • Traumatic injury which typically involves fall on outstretched hand
    • Wrist is hyper-extended with radial deviation

Risk Factors

  • Needs to be updated

Differential Diagnosis

Carpal Bone Fractures

Differential Diagnosis Wrist Pain

Clinical Features

Predictive characteristics of index tests (click to enlarge)[2]


  • Patients will some history of trauma
  • Will complain of wrist pain or thumb pain, worse with movement or activity

Physical Exam: Physical Exam Wrist

  • These 3 exam findings reported to be 100% sensitive, 74% specific for scaphoid fracture in first 24 hours following injury[3]
    • Scaphoid compression test
    • Snuffbox tenderness
    • Palpation of the volar scaphoid tubercle
  • Pain with resisted pronation

Special Tests


Possible scaphoid fracture with subtle lucency in the waist
Chronic scaphoid fracture with severe degenerative changes
CT of chronic scaphoid fracture with nonunion


  • Standard Radiographs Wrist
  • 3 view radiographs often sufficient
  • Scaphoid view: PA view in ulnar deviation
  • If negative but suspicious, repeat in 2-3 weeks


  • Most sensitive for occult fractures
  • Can evaluate for other soft tissue pathology


  • Useful for assessing
    • Fracture fragments
    • Extent of collapse
    • Pre-operative planning

Bone Scan

  • Falling out of favor, remains an option


Herbert and Fisher's Classification of Scaphoid Fractures

  • Type A: Stable acute fractures
    • A1: Tubercle fracture
    • A2: Incomplete waist fracture
  • Type B: Unstable acute fractures
    • B1: Distal oblique fractures
    • B2: Complete or displaced waist fracture
    • B3: Proximal pole fracture
    • B4: Transscaphoid perilunate dislocation fracture
    • B5: Comminuted fracture
  • Type C: Delayed union
  • Type D: Established nonunion
    • D1: Fibrous union
    • D2: Pseudoarthrosis



  • Indications
    • Stable, nondisplaced (majority)
    • Normal radiographs with high index of suspicion
  • Suspected Fracture
    • In patients with normal radiographs, but a high degree of clinical suspicion,
    • Patients should be placed in a thumb spica splint with repeat radiographs in roughly 1-2 weeks
  • Confirmed Fracture
    • Management decisions should be made in consultation with an orthopedic surgeon
    • The majority of scaphoid fractures are nondisplaced or minimally displaced
    • Can be treated with immobilization for 8-12 weeks in a thumb spica cast


  • Indications
    • Unstable fractures: proximal pole, >1 mm displacement
    • Displaced waist and proximal pole scaphoid fractures
    • High risk of delayed union, nonunion, or avascular necrosis
  • Technique
    • Percutaneus screw fixation
    • Open reduction, internal fixation

Rehab and Return to Play


  • Needs to be updated

Return to Play/Work

  • Dictated by physician
  • Minimum 6 weeks

Prognosis and Complications


  • Nonoperative
    • >90% of union in scaphoid fractures with <1 mm displacement (need citation)


See Also




  1. Hackney, Lauren A., and Seth D. Dodds. "Assessment of scaphoid fracture healing." Current reviews in musculoskeletal medicine 4 (2011): 16-22.
  2. Coventry, Laura, et al. "Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies." Emergency Medicine Journal (2023).
  3. Parvizi J, Wayman J, Kelly P, Moran CG. Combining the clinical signs improves diagnosis of scaphoid fractures. A prospective study with follow-up. J Hand Surg Br. 1998 Jun; 23(3):324-7
Created by:
John Kiel on 10 June 2019 01:01:55
Last edited:
7 June 2023 08:16:52
Trauma | Osteology | Wrist | Upper Extremity | Fractures | Acute