Where the scaphoid is
East Kent Hospitals explains that the scaphoid is one of the eight small bones of the wrist, called the carpal bones. It sits at the base of the hand, on the same side as the thumb. A scaphoid fracture is a break in this bone.
Fractures can affect different parts of the bone: the end nearest the fingers, the middle part (the waist) or the end nearest the forearm. East Kent Hospitals notes that the location matters, because fractures at one end of the scaphoid may need to be immobilised for longer.
How it breaks
Both NHS leaflets explain that a scaphoid fracture usually follows an unexpected force through the wrist and hand, typically a fall onto an outstretched hand.
The same kind of fall can also break the radius near the wrist or sprain the wrist ligaments, which is why any significant wrist injury after a fall should be assessed. See our guides on a sprained wrist and wrist pain.
Symptoms: pain on the thumb side
Cambridge University Hospitals explains that symptoms typically include pain and tenderness in the area just below the base of the thumb. Swelling and bruising are normal. East Kent Hospitals adds that the same pain can occur with a wrist sprain or bone bruising.
Being able to move your thumb or wrist does not rule out a fracture. Do not try to test the wrist yourself by pressing or forcing movements: assessment needs an examination and imaging by a health professional.
Why early X-rays can be normal
Cambridge University Hospitals explains that scaphoid fractures sometimes, but not always, show up straight away on X-ray. East Kent Hospitals notes that some are difficult to see on X-rays within the first week.
For this reason, further X-rays may be taken 10 to 14 days later, and sometimes an MRI scan is needed. It is important to attend every clinic or radiology appointment, even if the first X-ray was reported as normal.
Suspected vs confirmed fracture
East Kent Hospitals explains that if the doctor or nurse who sees you first is unsure, they may start treatment for a scaphoid fracture “just in case” and refer you to the fracture clinic. If a fracture is still suspected but not shown on an X-ray, you are usually seen again after a couple of weeks for repeat X-rays or referred for further scans.
While a fracture is suspected, follow the instructions you were given for the splint or cast. Cambridge University Hospitals advises keeping a removable splint on at all times, even at night, removing it only for hygiene.
Cast or splint treatment
East Kent Hospitals explains that many scaphoid fractures are treated successfully by immobilising the wrist, often in a plaster cast for six weeks, although your clinician may change this. Fractures at one end of the scaphoid may need to be immobilised for longer. During this time, do not use your hand or move your wrist without the cast or brace.
Both leaflets advise keeping your fingers moving, raising the hand in the first days, removing rings, keeping the cast dry and not putting anything inside it. East Kent Hospitals advises avoiding a sling, which can cause shoulder and neck discomfort, and avoiding heavy lifting, pulling or pushing for six to eight weeks.
When surgery is considered
East Kent Hospitals explains that an operation is occasionally needed, because of a poor blood supply to part of the bone. If surgery is advised, your clinician explains your options. The operation is usually a day case; afterwards the hand stays in a back slab for two weeks and then a cast for four to six weeks.
Serious complications are uncommon. East Kent Hospitals lists delayed wound healing or infection, a tender scar, nerve damage causing a painful spot or numbness, and, very rarely, complex regional pain syndrome.
Healing problems: non-union and blood supply
Non-union means that the broken bone fails to heal, even over a long period. East Kent Hospitals notes that it can still occur after surgery, in about 5 in every 100 patients when surgery is done within four weeks of injury. Part of the scaphoid has a poor blood supply, which is why some fractures heal more slowly or need surgery.
Stopping smoking greatly reduces the risk of the fracture not healing. This is one more reason not to miss follow-up appointments: checking that the bone is healing is part of treatment.
Where the sources differ
Cambridge University Hospitals (December 2023) gives brief first-aid style advice for people sent home from the emergency department. East Kent Hospitals (July 2024) is more detailed and includes surgery, exercises and return to activities. Both agree that initial X-rays may not show the fracture and that follow-up imaging matters.
East Kent Hospitals notes that most scaphoid fractures heal without problems, but gripping, full weight-bearing and repetitive work can be uncomfortable for up to a year. Its exercises should only start after your treating clinician has agreed. When the cast comes off and your trauma team authorises rehabilitation, our physiotherapy practice in Bilbao can help you recover movement and strength (consultations are in Spanish).
In summary
A scaphoid fracture is a break in a small wrist bone on the thumb side, usually from a fall onto an outstretched hand. It causes pain just below the base of the thumb and can be missed on early X-rays, so a suspected fracture is often immobilised and re-imaged. Most heal in a cast; some need longer immobilisation or surgery because of the bone’s blood supply.
A follow-up sheet helps with a suspected fracture: write down the date of injury, the date of the first X-ray, the type of splint or cast and how long to wear it, the date of repeat X-rays or MRI, and the symptoms to watch for. Bring it to every appointment.
Frequently asked questions about scaphoid fractures
These answers are general information and do not replace an examination or individual medical advice.
How serious is a scaphoid fracture?
Most heal without problems, but because part of the bone has a poor blood supply, some heal slowly or not at all. That is why follow-up matters.
Why can a scaphoid fracture be missed on X-ray?
Some are hard to see in the first week. Repeat X-rays after 10 to 14 days or an MRI scan may be needed if a fracture is still suspected.
Can you move your thumb with a scaphoid fracture?
Often yes. Moving the thumb or wrist does not rule out a fracture; pain at the base of the thumb after a fall needs assessment.
How long does it take to heal?
Many are in a cast for about six weeks, though some need longer. Regaining full strength and comfort can take several months.
When is surgery needed?
Occasionally, mainly because of poor blood supply to part of the bone. Your fracture clinic decides based on the type and location of the fracture.
What happens if it does not heal?
This is called non-union: the bone fails to mend. It is checked at follow-up appointments, and the clinic discusses treatment options.
Sources
- Cambridge University Hospitals NHS Foundation Trust · Scaphoid fractures
- East Kent Hospitals University NHS Foundation Trust · Scaphoid fracture
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.