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Date issued: December 2022

Review date: December 2024

Ref: A-553/NB/ED/Possible Scaphoid Fracture

PDF: Possible Scaphoid Fracture final December 2022.pdf [pdf] 127KB

What is the scaphoid bone (skay-foyd)?

The scaphoid is a small bone on the thumb side of your wrist.

What causes a scaphoid fracture?

Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall.  A fracture is the same as a break.

What are the symptoms?

Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:

• Pain, tenderness, or swelling on the thumb side of your wrist

• Difficulty gripping things or twisting your wrist or thumb

• Swelling around your wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken: x-rays only see the fracture in 80% of cases.

How is a scaphoid fracture diagnosed?

It is often difficult to diagnose a scaphoid fracture.  Usually, an x-ray is requested but this may not show the fracture immediately.  If this is the case, you may be asked to return to fracture clinic in 1-2 weeks for repeat examination.

In the clinic, if you still show the signs of a possible fracture a second x-ray will be performed.  This usually shows the fracture but sometimes does not.  If there is continuing suspicion, then an MRI scan will be requested.

What happens in the meantime?

The scaphoid bone has a poor blood supply and, as a result, it is important that a fracture is not missed.  We will assume the bone is broken until we are certain it is not as this is the safest option for you.

This involves placing the affected wrist in a splint.  This should be worn all the time, but it can be taken off for washing.  The splint is also washable – instructions are on the inside. Make sure the metal bar is removed before you wash it!

The splint will help from a pain relief point of view, but can be supplemented with simple painkillers:

Paracetamol is useful to ease pain. It is best to take it regularly for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. A doctor may prescribe additional painkillers such as codeine if the pain is more severe.  If you are prescribed a combination of paracetamol and codeine (eg cocodamol or codydramol) then it is important not to take additional paracetamol as you will accidentally overdose
Anti-inflammatory medication can be used with paracetamol or as an alternative. There are many types and brands. They relieve pain and reduce inflammation and swelling (often the cause of the pain). You can buy ibuprofen at pharmacies or supermarkets without a prescription. The dose varies depending on your age and other medical problems. Side-effects sometimes occur with anti-inflammatory painkillers. Ask your doctor or pharmacist for advice regarding them

If pain is not controlled by these simple painkillers, do not exceed the recommended dose but see your general practitioner to discuss the possibility of stronger painkillers.

What if it is broken?

Treatment for scaphoid fractures includes wearing a splint or plaster cast.  In general terms, if the bone is broken then you will require a plaster which you will need to wear for 6 weeks.  Occasionally a bad fracture may need an operation.