Scaphoid Fracture by Sinead Noonan

What is it?

A scaphoid fracture is a common injury that can occur from a fall onto an outstretched hand. It can be a challenging fracture to diagnose however and if not treated correctly it can lead to long term problems. Scaphoid fractures account for up to 62% of all carpal fractures (Hayat & Varacallo, 2023). 

Practitioners of Hand Therapy have a huge role to play in both the diagnosis, treatment and rehabilitation following a scaphoid fracture. Rehabilitation involves a graded approach to return to activities of daily living and desired occupations.


Diagnosis of a scaphoid fracture is based on physical examination such as wrist swelling, tenderness over the anatomical snuffbox and by a scaphoid compression test. A scaphoid fracture is often detected on an x-ray however 30% of all scaphoid fractures may be missed on initial radiographs. MRI testing for a scaphoid fracture is described in the UK’s NICE guidelines (2016) as the ‘gold standard’ for confirming the presence of a scaphoid fracture.

Differential diagnosis:

  • Distal radius fracture
  • Other carpal bone fractures 
  • Ligament injury for e.g. Scapho-Lunate 
  • DeQuervains tenosynovitis 
  • Tendonitis


The most appropriate treatment for a scaphoid fracture depends on many different factors such as fracture location, type and displacement and will be determined by the treating doctor. Other considerations include a person’s age, activity levels and general health (Alshryda et. Al., 2012).

The most used classification system for a scaphoid fracture is based on expected fracture instability which is Herberts classification (TenBerg et al., 2016).

Fractures which are non-displaced and located at the distal third of the bone can generally be managed non-operatively in a cast. There is active debate whether the thumb should be included in this type of cast. Casting for a non-displaced scaphoid fracture can result in temporary joint stiffness and muscle weakness. Casting can also lead to a delay in return to work and sporting activities, this is why hand therapy is recommended for rehabilitation following casting.

Operative techniques are common in a scaphoid fracture.

Percutaneous screw is indicated for unstable fractures as shown by displacement >1mm or for non-displaced fractures for a quicker return to sport. An open-reduction internal fixation is indicated for significantly displaced fractures, unstable vertical fractures, or oblique fractures (Bond et al., 2001).

Outlook following a scaphoid fracture:

If a scaphoid fracture is not identified or not treated correctly immediately you are at risk of the following complications:

  • Delayed union/ non-union
  • Avascular necrosis (the blood supply to the bone is cut off which can cause the bone to collapse)
  • Decreased wrist range of motion and function

Hand Therapy following a scaphoid fracture. Your hand therapist can:

  • Apply a comfortable waterproof cast, brace or orthosis as prescribed by the treating doctor.
  • Provide you with a personalised home exercise programme to progress range of motion, strength, and function.
  • Use outcome measures to monitor progress and adapt your treatment.
  • Assist you with pain management and oedema management strategies.
  • Provide advice regarding management at home and recommended functional use based on your stage of healing.

Return to activities of daily living after a scaphoid fracture:

Return to work following a scaphoid fracture varies. Generally, you could return within 2-4 weeks if you have an office job. For more physical jobs it can take approximately 3 months. 

Return to driving– depends on treatment however normally 8 weeks.

Return to sport– It typically takes 3 months or longer to return to sport following a scaphoid fracture.

For sports that require significant wrist motion like tennis or hockey it may take a little longer.

For athletes, as they have a high demand to return to work, surgical intervention is mostly recommended.


Alshryda, S., Shah, A., Odak, S., AlShryda, J., Ilango, B., Murali, S.R. Acute fractures of the scaphoid bone. Systemativ review and meta-analysis. The surgeon. 2012. 10(4) pp218-229.

Hayat Z, Varacallo M. Scaphoid Wrist Fracture. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

Bond, Charles D. MD; Shin, Alexander Y. MD; McBride, Mark T. MD; Dao, Khiem D. MD. Percutaneous Screw Fixation or Cast Immobilization for Nondisplaced Scaphoid Fractures. The Journal of Bone & Joint Surgery 2001. 83(4):p 483.

Goffin JS, Liao Q, Robertson GA. Return to sport following scaphoid fractures: A systematic review and meta-analysis. World J Orthop 2019; 10(2): 101-114

 Ten Berg PW, Drijkoningen T, Strackee SD, Buijze GA. Classifications of acute scaphoid fractures: a systematic literature review. J Wrist Surg 2016;5:152–159

Rhemrev, S.J., Ootes, D., Beeres, F.JP., Meylaerts, S.AG. & Schipper, I.B. Current methods of diagnosis and treatment of scaphoid fractures. International Journal of Emergency Medicine. 2011. 4.4 

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