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Scaphoid fracture
A scaphoid fracture after a fall on an outstretched hand may not show on the first radiograph, and because its blood supply enters from the distal end it is prone to non-union and necrosis of the proximal pole; so clinical suspicion calls for immobilisation and further imaging even when radiographs are normal.
Why it matters in the exam
The typical stem describes a young adult who fell on an outstretched hand with pain on the radial side of the wrist, tenderness in the anatomical snuffbox, tenderness over the scaphoid tubercle and pain on axial compression of the thumb. Dedicated scaphoid radiographs may be normal at first. Under NICE guidance, when there is clinical suspicion and a normal radiograph, MRI is the preferred next test; if MRI is not available, the wrist is immobilised and radiographs repeated or CT performed. The blood supply to the scaphoid enters mainly from the distal end and flows toward the proximal end, so the closer the fracture is to the proximal pole, the higher the risk of necrosis and non-union. The waist is the most common site. An undisplaced waist fracture is usually treated in a cast or splint for about 6–8 weeks, and sometimes with screw fixation to shorten immobilisation in athletes or manual workers; a fracture displaced by more than 1 mm, a proximal pole fracture and a fracture diagnosed late are usually treated with internal screw fixation. Untreated non-union gradually leads to wear and collapse of the wrist (SNAC), so even mild pain after a fall deserves investigation. In children scaphoid fractures are less common and usually heal better.
Key points
- Fall on an outstretched hand with snuffbox tenderness — suspect a scaphoid fracture.
- The first radiograph may be normal; MRI is the preferred next test.
- Blood supply from the distal end — risk of proximal pole necrosis.
- Undisplaced waist — cast; displaced or proximal pole — screw.
- Non-union leads to wear (SNAC).
Summary table
| Situation | Finding | Treatment | Note |
|---|---|---|---|
| Clinical suspicion with normal radiograph | Snuffbox or tubercle tenderness | Immobilisation and MRI | Without MRI — repeat radiograph or CT |
| Undisplaced waist fracture | Fracture line without displacement | Cast or splint about 6–8 weeks, or screw | The most common site |
| Displaced fracture | Displacement of more than 1 mm or angulation | Internal screw fixation | High non-union risk with conservative care |
| Proximal pole fracture | Fracture close to the radius | Internal screw fixation | High risk of necrosis |
| Non-union | Open fracture line after months | Fixation with bone graft | Untreated — wear and collapse (SNAC) |
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Sources
- NICE Guideline NG38, 2016 — Fractures (non-complex): assessment and management
- Green's Operative Hand Surgery, 8th ed. (2022) — Fractures of the Carpus: Scaphoid
- Rockwood and Green's Fractures in Adults, 9th ed. (2019) — Carpus Fractures and Dislocations
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.