Wrist fractures, including scaphoid fractures, involve a break in one or more of the wrist bones, often causing pain and swelling.
The wrist is formed where the two forearm bones, the radius and ulna, meet a group of eight small carpal bones. A fracture can involve any of these bones, though the distal radius, the end of the larger forearm bone, is by far the most common site of wrist fracture overall.
The scaphoid, one of the small carpal bones on the thumb side of the wrist, deserves particular mention. Its blood supply enters from one end, which means fractures here can be slow to heal, or in some cases fail to heal, if not identified and treated appropriately. Scaphoid fractures can also be subtle and are sometimes not visible on the first X-ray taken after injury.
The great majority of wrist fractures result from a fall onto an outstretched hand. In younger people, this is often from higher-energy activities such as sport, cycling or a motor vehicle accident, while in older adults it more commonly follows a simple fall from standing height, particularly where bone density is reduced.
Common symptoms of a wrist fracture include:
Persistent tenderness at the base of the thumb after a fall, even if an initial X-ray looks normal, can indicate a scaphoid fracture not yet visible on imaging, and is worth reassessing if symptoms continue.
Assessment includes examination of the wrist, with particular attention to the base of the thumb, and X-rays to identify the fracture. Where a scaphoid fracture is suspected but not clearly visible on the initial X-ray, a period of splinting with repeat imaging, or an MRI or CT scan, may be used to confirm or exclude the diagnosis.
Stable, non-displaced distal radius fractures are often managed with a cast. Displaced or unstable fractures generally require surgical fixation with plates and screws to hold the bone in the correct position.
Most scaphoid fractures with any displacement, and many that are non-displaced but at higher risk of poor healing, are treated with surgical fixation, typically using a single screw, to give the fracture the best chance of reliable healing.
Distal radius fractures generally heal well with appropriate treatment, whether in a cast or with surgical fixation for more significant injuries. Scaphoid fractures carry a higher risk of delayed healing or non-union, particularly if diagnosed late or if the fracture is displaced, given the bone's limited blood supply, which is why accurate diagnosis and, where needed, early surgical fixation are emphasised for this specific fracture.
Wrist fractures are common injuries, most often following a fall onto an outstretched hand. Distal radius fractures generally heal well with appropriate treatment, while scaphoid fractures need particular care given their tendency to heal slowly, or occasionally not at all, if not managed correctly. Persistent wrist pain and tenderness after a fall, even with a normal initial X-ray, is worth having reassessed.
For a general guide to what to expect during recovery, see what to expect after a hand or wrist fracture.
