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Scaphoid fracture surgery
Scaphoid fracture surgery stabilises a break in the scaphoid, one of the small wrist bones most vulnerable to injury after a fall onto an outstretched hand, using one or more screws to hold the fragments together. Surgical fixation may be recommended because the scaphoid’s limited blood supply can make these fractures slow to heal or prone to nonunion without stable fixation.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
One to two weeks after surgery
Driving
Not until the wrist is out of cast/splint and you have adequate strength and control
Post Operative Hand Therapy
Required for splinting and to restore wrist movement and grip strength
Splinting
Yes - a splint is worn while the fracture heals, even after screw fixation
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 8-12 weeks depending on fracture location and healing on x-ray/CT
Surgical fixation of a broken scaphoid (wrist) bone
Scaphoid fracture fixation is surgery to stabilise a broken scaphoid, one of the small bones of the wrist, using a compression screw.
The scaphoid has a precarious blood supply, particularly at its proximal end, which makes fixation important for fractures at higher risk of not healing.
Who is this procedure for?
- People with a displaced scaphoid fracture, which has a high risk of nonunion (failure to heal) if treated with immobilisation alone
- People with a fracture through the proximal pole of the scaphoid, an area with a precarious blood supply and high nonunion risk
- People who want to avoid prolonged cast immobilisation (often 8-12 weeks) for an undisplaced fracture and prefer earlier mobilisation with surgical fixation
- People with an established scaphoid nonunion from a previously undiagnosed or untreated fracture
What does the surgery involve?
Surgery involves inserting a compression screw along the length of the scaphoid to hold the fracture fragments together under compression, encouraging healing. This can often be done percutaneously (through a small incision, guided by x-ray) for straightforward fractures, or through an open approach for more complex fractures or established nonunions, which may also require bone grafting to stimulate healing.
Alternatives to surgery
Surgical fixation is one option for a scaphoid fracture. Depending on your situation, the alternatives may include:
- Splint/Cast immobilisation alone: appropriate for stable, undisplaced fractures, typically requiring 6-12 weeks in a cast, but with a real risk of nonunion for higher-risk fracture patterns
- Percutaneous versus open screw fixation: the choice depends on fracture displacement, location and whether it is an acute fracture or established nonunion
- Bone grafting: required for established nonunions where the bone has not healed and there is a bone defect
What happens if left untreated: an untreated or missed scaphoid fracture has a significant risk of progressing to nonunion, which over time can lead to a specific pattern of wrist arthritis (SNAC wrist).
Dr Tomlinson will discuss which options suit your specific fracture at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves and the fracture pattern. If your work is desk-based, you may return within one to two weeks with the wrist protected in a splint that you wear at all times.. If your work is physical or requires wrist loading, you’ll usually need 6-12 weeks, until union is confirmed on imaging. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for two weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions. (If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.)
How long will I need to wear a splint?
A cast or splint is worn even after screw fixation, since the screw alone does not provide full protection against the forces through the wrist. Duration is typically 6-8 weeks but is guided by x-ray or CT confirmation of healing, as the scaphoid can be slow to unite.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Hand therapy is commonly recommended once the cast is removed, to help restore wrist range of motion and grip strength, both of which are commonly reduced after a period of immobilisation.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Nonunion, where the fracture fails to heal, particularly for fractures higher up the bone
- Avascular necrosis (loss of blood supply to part of the bone), again more likely with fractures higher up the scaphoid
- Ongoing wrist pain or reduced movement
- Screw position requiring adjustment or further surgery
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand may have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. You may use your hand to lift objects up to 300 grams, but avoid use of the hand where there are other alternatives. You should find that the post operative discomfort reduces steadily after around 72 hours after surgery.
Second week
The wrist remains in a cast or splint. Finger and thumb movement is encouraged to maintain flexibility while the wrist itself is protected.
6 weeks
While it is inconvenient to still be wearing a splint at all times, your post operative x-ray and CT will check the bone healing, and once this is progressing satisfactorily your hand therapist will commence you on gradual strengthening of your hand and wrist and also wrist range of movement exercises.
3 months
If your x-ray and CT confirm appropriate bone healing you will be able to return to normal activities under the guidance of your hand therapist. It may take some months to regain full strength in the forearm muscles.
Long term
Healing is confirmed with x-ray or CT imaging, typically around 6-12 weeks depending on fracture location, as the scaphoid can be slow to unite, particularly proximal pole fractures. Return to contact sport or heavy wrist loading is usually deferred until union is confirmed.
Want to know more about Scaphoid Fracture Fixation?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.