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Hand & Wrist

Scaphoid Fracture: the wrist fracture that hides.

The scaphoid is the most commonly fractured carpal bone, and its fragile blood supply makes early, accurate treatment important. A scaphoid fracture can be invisible on the first X-ray, so a wrist injury with snuffbox tenderness is treated as a fracture until proven otherwise.

Written bySteven J. Lee, MD · Chief of Hand and Upper Extremity Surgery, Lenox Hill Hospital
Last reviewed · May 2026

The scaphoid is a small bone on the thumb side of the wrist that links the two rows of carpal bones and is essential to normal wrist motion. It is the most commonly fractured of the carpal bones, usually from a fall onto an outstretched hand.

The scaphoid has an unusual and fragile blood supply that enters from one end and runs backward through the bone. A fracture can cut off blood flow to part of the bone, which is why scaphoid fractures are prone to slow healing, non-union (failure to heal), and in some cases loss of the bone's blood supply. Prompt, correct treatment is what prevents those problems.

Why it is easy to miss

Many scaphoid fractures do not show on the first set of X-rays. The classic sign is tenderness in the anatomic snuffbox, the small hollow at the base of the thumb. Because a missed scaphoid fracture can go on to non-union and arthritis, a wrist with this tenderness is splinted and treated as a fracture even when the initial X-ray looks normal, then re-imaged or studied with MRI or CT.

Symptoms

Common findings after a fall include:

  • Pain and tenderness in the snuffbox at the base of the thumb
  • Swelling and reduced grip on the thumb side of the wrist
  • Pain with pinching or pushing through the wrist
  • Symptoms that are easy to dismiss as a sprain
Dr. Lee's approach

Dr. Lee's first priority is not to miss the fracture. A wrist with snuffbox tenderness after a fall is protected and imaged appropriately, because the cost of treating a true fracture as a sprain can be high.

Once a fracture is confirmed, treatment depends on its location and stability. Non-displaced fractures of the waist or far end of the scaphoid can heal in a cast, though healing is slow. Fractures that are displaced, unstable, near the proximal end, or already showing signs of non-union are treated surgically with a small headless compression screw or a plate, sometimes with a bone graft to stimulate healing. The decision balances the reliability of healing against the time and immobilization a cast requires, which matters a great deal to active patients.

Cast/Brace treatment

Non-displaced, stable fractures can heal in a cast/brace. Scaphoid bone heals slowly because of its blood supply, so casting can take two to three months or longer, and healing is confirmed on imaging before the cast comes off.

Screw or plate fixation

Displaced or unstable fractures, proximal fractures, and many fractures in active patients are treated with a headless compression screw placed across the fracture, often through a small incision. Fixation stabilizes the bone, supports healing, and can shorten the period of immobilization compared with a cast.

Surgery for non-union

A scaphoid that has failed to heal is treated by removing the non-union tissue, restoring the bone's shape, adding a bone graft to stimulate healing, and fixing it with a screw or a plate. Addressing a non-union before arthritis develops is what protects the long-term function of the wrist. Those fractures that have lost their blood supply might be treated with a vascularized bone graft.

Recovery timeline

Recovery depends on the fracture and the treatment:

  1. Cast, weeks 0 to 8 or longer
    Thumb-spica cast. Healing is confirmed on X-ray or CT before discontinuing immobilization.
  2. After screw fixation, weeks 0 to 2
    Splint, wound care, and early finger and shoulder motion. Light use of the hand for daily tasks.
  3. After screw fixation, weeks 2 to 12
    Bracing for at least 6 weeks. Progressive wrist motion and strengthening in hand therapy may start week 6, with return to sport and heavy use guided by healing on imaging.

What patients commonly misunderstand

What patients should know:

  • A normal first X-ray does not clear it. Scaphoid fractures are often invisible on the day of injury. Snuffbox tenderness is treated as a fracture until repeat imaging or MRI says otherwise.
  • It is not just a sprain. A scaphoid fracture mistaken for a sprain and left untreated can fail to heal and lead to a predictable pattern of wrist arthritis. Early evaluation is what prevents that.
  • Healing is slow by nature. Because of its blood supply, the scaphoid heals more slowly than many bones. Patience and confirmed healing on imaging are part of the process, whether treated in a cast or with a screw. Dr. Lee may opt to use a bone stimulator to help with bone healing.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Patient questions

Scaphoid fractures, answered.

  • My wrist X-ray was normal but it still hurts. Could it be broken?

    Yes. Scaphoid fractures frequently do not appear on the first X-ray. If you have tenderness in the snuffbox at the base of the thumb after a fall, it is treated as a fracture until repeat imaging, an MRI, or a CT confirms whether the bone is broken. Treating it this way prevents a missed fracture from failing to heal.

  • Do I need surgery for a scaphoid fracture?

    Not always. Non-displaced, stable fractures can heal in a cast, though healing is slow. Displaced or unstable fractures, fractures near the proximal end, and many fractures in active patients are treated with a small screw, which stabilizes the bone and can shorten immobilization. The choice depends on the fracture and your activity level.

  • What happens if a scaphoid fracture is not treated?

    Because of the bone's fragile blood supply, an untreated scaphoid fracture can fail to heal, a condition called non-union. Over time a chronic non-union leads to a predictable pattern of wrist arthritis (SNAC wrist). This is why early diagnosis and treatment matter, and why a non-union is addressed before arthritis sets in.

  • How long does a scaphoid fracture take to heal?

    Longer than many bones. Cast treatment often takes two to three months or more, with healing confirmed on imaging before the cast is removed. After screw fixation, hand use returns gradually over several weeks, with return to sport and heavy loading guided by evidence of healing rather than the calendar alone. Bone stimulator can accelerate healing time.

Next step

Wrist still sore after a fall? A scaphoid fracture is worth ruling out.

The scaphoid is the most commonly fractured carpal bone, and it can hide on the first X-ray. Snuffbox tenderness deserves a careful evaluation, because early, accurate treatment is what prevents non-union and the arthritis that can follow.

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