Scaphoid fracture fixation is an operation to stabilise a broken scaphoid bone in the wrist using a small headless screw. The scaphoid has a vulnerable blood supply, and surgical fixation may be recommended to promote healing and allow earlier return to activity.
A small incision is made on the front or back of the wrist. Under X-ray guidance, a headless compression screw is inserted across the fracture to hold the bone fragments together and promote healing. The operation takes 30–60 minutes and is usually performed as a day case.
Surgery is recommended for displaced scaphoid fractures, fractures of the proximal pole (which has the poorest blood supply), fractures that have failed to heal with cast treatment (non-union), and in active patients who wish to return to sport or manual work more quickly.
Undisplaced waist fractures may be treated with a plaster cast (including the thumb) for eight to twelve weeks. Cast treatment has high healing rates for undisplaced fractures but requires prolonged immobilisation.
CT scan to assess displacement. Standard pre-assessment.
High healing rates (over 95% for acute fixation). Earlier return to function compared to cast treatment. The screw is buried within the bone and does not need removal.
Small but may be sensitive.
Temporary loss of movement improving with exercises.
The scaphoid may still fail to heal despite fixation, particularly with proximal pole fractures. May require bone grafting.
Loss of blood supply to part of the scaphoid, causing bone collapse.
The screw may protrude slightly and irritate tendons.
Small sensory nerve branches may be damaged.
Wound infection.
General, regional, or local anaesthesia.
A splint or cast may be worn for two to six weeks depending on the fracture and fixation. Hand therapy to restore movement and grip strength. Return to desk work within days. Return to sport at six to eight weeks for non-contact activities. Full healing at eight to twelve weeks.
X-ray and review at six weeks and three months to confirm healing. CT scan may be used to assess union.
The scaphoid has a retrograde blood supply — blood enters from one end and travels backwards. This means fractures at the proximal pole have a higher risk of non-union and avascular necrosis.
Yes. The headless screw is buried within the bone and does not normally cause problems. It does not need to be removed.