Trauma

Scaphoid Fracture

Scaphoid fracture treatment in Townsville - non-surgical and surgical management including percutaneous screw fixation. Dr Jonathon de Hoog, Aspire Orthopaedics.

Performed at: Townsville Day Surgery Mater Hospital Pimlico

What is a scaphoid fracture?

The scaphoid is a small bone on the thumb side of the wrist that plays a disproportionately important role in wrist mechanics. Scaphoid fractures most commonly occur after a fall onto an outstretched hand, particularly in young adults.

Scaphoid fractures are notorious for two reasons: they are easy to miss on initial X-rays, and the blood supply to the scaphoid is precarious - certain fractures can fail to heal (non-union) or develop bone death (avascular necrosis), leading to long-term problems.

Symptoms

  • Pain in the wrist on the thumb side, often in the “anatomical snuffbox”
  • Pain with gripping or twisting
  • Reduced wrist movement
  • Often appears as a “sprained wrist” that doesn’t improve

Diagnosis

  • Plain X-rays - first-line investigation, but up to 25% of scaphoid fractures are not visible on initial X-rays
  • MRI or CT - the gold standard for confirming a suspected scaphoid fracture when X-rays are negative
  • Clinical re-examination at 10-14 days - if imaging is not immediately available, a fracture may become apparent on repeat X-ray

Any wrist injury with snuffbox tenderness after a fall should be treated as a scaphoid fracture until proven otherwise.

Non-surgical treatment

Undisplaced scaphoid fractures can often be treated in a cast:

  • Cast immobilisation for 8-12 weeks, depending on the fracture location
  • The further up the bone the fracture is (closer to the wrist), the longer the healing time due to the blood supply
  • Regular X-ray review to confirm healing

Surgical treatment

Surgery is considered for:

  • Displaced fractures
  • Fractures that haven’t healed after a period in a cast
  • Proximal pole fractures (higher risk of non-union)
  • Some patients - particularly manual workers or athletes - who want to avoid a prolonged cast

The typical procedure is percutaneous screw fixation: a single specialised screw is placed down the length of the scaphoid through a small incision, compressing the fracture and allowing early mobilisation.

  • Performed at Townsville Day Surgery or Mater Hospital Pimlico
  • Regional block with light sedation
  • Usually a day procedure
  • You go home the same day with a light splint

Recovery

  • Weeks 1-2 - splint for comfort; early gentle wrist movement
  • Weeks 2-6 - progressive return to wrist movement under hand therapy guidance; desk work within 1-2 weeks
  • Weeks 6-12 - return to manual work and most sport as fracture healing is confirmed on imaging
  • Up to 6 months - full recovery of grip and wrist function

For established non-unions or complex cases, bone grafting with vascularised or non-vascularised grafts may be required, with longer recovery.

Risks

  • Non-union - failure of the fracture to heal; more common in proximal pole fractures
  • Avascular necrosis - loss of the blood supply to part of the bone
  • Stiffness - uncommon with early mobilisation after screw fixation
  • Hardware irritation - occasional, rarely requires removal
  • Infection - rare

Recovery timeline

What to expect at each stage of your recovery.

  1. Acute assessment

    Urgently

    X-rays first. MRI or CT if X-rays are negative but clinical suspicion is high. Any snuffbox tenderness after a fall treated as scaphoid fracture until proven otherwise.

  2. Treatment

    Varies

    Undisplaced fractures may be cast for 8-12 weeks. Surgery (percutaneous screw) if displaced, proximal pole, or patient prefers early mobilisation.

  3. Wound / cast check

    1-2 weeks post-treatment

    Early gentle wrist movement after surgery. Cast review and X-rays for conservatively managed fractures.

  4. Return to activities

    6-12 weeks

    Return to manual work and most sport as healing is confirmed on imaging. Up to 6 months for full grip and wrist function.

Common questions

Frequently asked questions about this procedure.

Can a scaphoid fracture be missed on X-ray?

Yes - up to 25% of scaphoid fractures are not visible on initial X-rays. If you have pain in the anatomical snuffbox (the hollow on the thumb side of the wrist) after a fall, it should be treated as a scaphoid fracture until proven otherwise, even if initial X-rays are normal. MRI or CT scanning are the gold standard for confirming the diagnosis.

Can a scaphoid fracture be treated without surgery?

Yes. Undisplaced scaphoid fractures can often be treated in a cast for 8-12 weeks. However, surgery (percutaneous screw fixation) allows earlier mobilisation and reduces time away from work or sport. Displaced fractures, proximal pole fractures, and fractures that fail to heal in cast almost always require surgery.

When can I drive after a scaphoid fracture?

After surgical fixation with percutaneous screw, desk work is typically possible within 1-2 weeks and driving often follows from 2-4 weeks depending on which wrist is affected and your recovery. This will be discussed at follow-up. Conservative management in a cast restricts driving for the duration of immobilisation.

What is avascular necrosis of the scaphoid?

The blood supply to the scaphoid enters at the distal end, meaning fractures closer to the wrist (proximal pole) have a higher risk of the fragment losing its blood supply (avascular necrosis or AVN). AVN can lead to bone death and eventual wrist arthritis if untreated. This is why proximal pole fractures are taken seriously and often recommended for surgical fixation.

Speak with Dr de Hoog

A GP referral is required to see Dr de Hoog. Ask your GP to refer you to Aspire Orthopaedics, or contact the rooms directly for guidance.

Get a referral Email the clinic