Scaphoid Fractures and Non-Union

The scaphoid is one of the small carpal bones on the thumb side of the wrist, and it is the most commonly fractured carpal bone, usually from a fall onto an outstretched hand. Because part of the scaphoid has a limited blood supply, and wrist movement may apply loads at the fracture site that discourage bone healing, scaphoid fractures are at risk of not healing (non-union). Early diagnosis and appropriate treatment increases the likelihood of the fracture healing reliably.

Scaphoid fractures are most often caused by a fall onto an outstretched hand or sporting injuries. Non-union is more likely with delayed diagnosis (a delay to immobilisation), being unable or unwilling to immobilise the wrist after diagnosis, or an unfavourable fracture pattern, such as a proximal pole or waist fracture.

Any wrist pain after a fall onto an outstretched hand, especially with tenderness at the base of the thumb, should be assessed, even if the pain seems mild. Some scaphoid fractures cause only mild pain and can be mistaken for a simple sprain.

Much of the initial treatment for a scaphoid fracture involves immobilisation in a cast or splint. Once the fracture has healed, or after surgery, a hand therapist can help with rehabilitation of wrist movement and strength.

Dr Tomlinson will examine your wrist and arrange an x-ray, with further imaging such as CT or MRI if a fracture is suspected but not clearly seen. Many scaphoid fractures, particularly those that are non-displaced and in the part of the bone with a better blood supply, can be treated successfully in a cast. Fractures that are displaced, or at higher risk of not healing, are often treated surgically with a screw to hold the bone in place while it heals. Dr Tomlinson treats and fixes straightforward scaphoid fractures; more complex fracture patterns and cases of established non-union are generally referred to a Melbourne colleague with additional experience in specialised bone grafting and reconstruction techniques.

At your appointment, Dr Tomlinson will examine your wrist and arrange an x-ray, with further imaging if a fracture is suspected but not clearly seen. Together you will discuss cast treatment versus surgery, and whether your fracture is one she will manage directly or refer on.

The scaphoid has a limited blood supply, so an untreated fracture can fail to heal (non-union) and lead to wrist osteoarthritis over time. Because early x-rays can miss a scaphoid fracture, a suspected fracture with a normal initial x-ray is often treated in a splint and reassessed after 10 to 14 days, rather than dismissed.