Scaphoid Fracture

Description

The scaphoid is a small boat-shaped bone on the thumb side of the wrist. A scaphoid fracture usually follows a fall onto an outstretched hand. This bone deserves respect: it can be tender with little to see on an early X-ray, and it heals more slowly than most.

How it happens (the mechanism)

A fall loads the scaphoid as it bridges the wrist, and it cracks across. The reason it heals slowly is its blood supply: much of the scaphoid is fed from one end, so a break can leave the other part poorly supplied — which is why these can be slow to knit and, if ignored, can fail to heal.

What matters

Because an early scaphoid fracture can be nearly invisible on X-ray, a wrist that is tender in the telltale spot (the “snuffbox” at the base of the thumb) is often treated as a fracture even when the first X-ray looks normal, with re-imaging later. A few weeks in a cast for a wrist that turns out to be only bruised is a small price compared with missing a break that then fails to heal.

Symptoms

Pain and tenderness at the base of the thumb side of the wrist, sometimes with mild swelling and reduced grip.

Doctor examination and imaging

The doctor checks for tenderness in the snuffbox; X-rays may be repeated after a couple of weeks, and occasionally an MRI or CT is used to confirm a suspected fracture.

Treatment

Most scaphoid fractures are treated in a cast, sometimes longer than other wrist fractures. A displaced fracture may need surgery with a small screw.

Recovery and long-term outlook

With proper immobilization, most heal well; the careful, sometimes lengthy casting reflects this bone’s slower healing.

When to call the doctor

Call the office right away if your child’s fingers become numb, pale, blue, or cold; pain keeps worsening even after raising the arm and giving medicine; swelling does not improve with elevation; the cast feels too tight, cracked, or wet, or smells bad; or your child develops a fever.

Learn more

OrthoInfo (AAOS) — Forearm Fractures in Children: orthoinfo.aaos.org

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.