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Scaphoid Fracture

Scaphoid fractures — recognition, the high non-union risk, casting and percutaneous/open fixation.

76 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Scaphoid fractures remain a challenging injury with high nonunion rates despite improvements in diagnosis and surgical techniques [6]. Pediatric scaphoid fractures, however, are associated with excellent outcomes [1]. The evidence base for many management principles is limited, with numerous decisions relying on small case series rather than robust data [3].

Indications: Operative intervention is recommended for displaced scaphoid fractures [24]. Appropriately performed acute percutaneous internal fixation is a standard treatment option for selected patients with acute scaphoid fracture [5]. Early internal fixation is increasingly favored even for nondisplaced scaphoid fractures [6]. Conversely, internal fixation does not demonstrate a true long-term benefit compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [7]. Nondisplaced scaphoid fractures can be effectively treated nonoperatively, with union rates approaching or exceeding those of operative intervention [24].

Outcomes and Complications: Virtually all united scaphoid fractures result in a good outcome, regardless of malunion [15]. For patients with recent scaphoid fractures that failed initial treatment, distal scaphoid resection is a viable option [31]. The optimal protocol for postoperative immobilization following operative treatment remains controversial [33].

Anatomy & Pathophysiology

Kinematics and Instability

Scaphoid nonunions dramatically impact carpal kinematics by partially uncoupling the proximal and distal carpal rows [41]. Vascularized bone grafting restores normal scaphoid geometry and permits normal carpal kinematics in the treatment of scaphoid nonunions associated with proximal pole avascular necrosis and carpal collapse [53]. Biomechanical studies demonstrate that osteotomies can reliably shift load away from the scaphoid and lunate [54].

Anomalous carpal kinematics caused by lunotriquetral coalition may predispose both scaphoid bones to fracture, although causality cannot be proven [69]. Scaphoid motion during forearm and thumb motion is not significant in casts for scaphoid fractures [50].

Pathomechanics and Classification

Scaphoid Nonunion Advanced Collapse (SNAC) wrists differ from Scapholunate Advanced Collapse (SLAC) wrists by exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [48]. Radiographic classification of SLAC wrist has moderate reliability and reproducibility [72]. Radiographic classification of SNAC wrist has limited reliability [72].

Clinical Outcomes and Morphology

Residual scaphoid deformity has no relevant negative impact on mid-term wrist function [13]. Patients with distal scaphoid fractures report normal self-assessed hand function, good wrist motion, and good strength at 8- to 11-year follow-up [14]. Radiocarpal-based lunate morphology is not associated with scaphoid fracture [64].

Classification

Age-Based Pediatric Classification: Pediatric scaphoid fractures are classified by age and ossification status [30]. Type 1 (chondral or partial ossific nucleus involvement) occurs in children younger than 8 years; Type 2 (osteochondral) occurs in patients aged 8 to 11 years; Type 3 (osseous, behaving like adult fractures) occurs in adolescents aged ≥12 years [30].

Anatomic Pediatric Classification: Pediatric scaphoid fractures are classified by anatomic location into tuberosity, transverse distal pole, avulsion distal pole, waist, and proximal pole [30]. Fractures of the distal third of the scaphoid are the most common type in children [30].

Nonunion Classification Systems: Scaphoid nonunions are described by anatomic location or clinical terms including stable, fibrous, sclerotic, unstable, humpback, synovial, cystic, pseudarthrosis, or avascular [82]. A revised classification divides them into early nonunions without substantial bone resorption and older nonunions with substantial bone resorption [82]. The Slade and Geissler classification includes Type 1 (delayed presentation for 4–12 weeks) and Type 2 (fibrous union, minimal fracture line) [84].

SNAC Staging: Scaphoid nonunion advanced collapse (SNAC) staging is defined by Vender et al. as Stage 1 (arthrosis between distal scaphoid fragment and radius), Stage 2 (narrowing of the scaphocapitate joint), and Stage 3 (degenerative involvement of the capitolunate joint) [83]. The inter- and intra-observer reliability of the Vender et al. SNAC classification is poor [83].

Other Considerations: There is no consensus regarding the imaging modality and measurements used to define a scaphoid fracture as 'nondisplaced' [4]. There is a need for a consensus definition of scaphoid fractures on MRI scans to assess reliability and diagnostic performance [9].

Clinical Presentation

The clinical diagnosis of scaphoid fractures is inherently uncertain. Conventional radiographs combined with two clinical examinations identify true fractures in only about 40% of patients [2]. Radiography remains the initial imaging modality due to low cost and availability, but its sensitivity is up to 64% [44]. The negative predictive value of initial radiographs ranges from 50%-87%, with a weighted average of 74% [44]. Consequently, traditional diagnostic pathways relying solely on radiographs are inappropriate for ruling out a fracture [44]. Dependence on radiographs leads to false-positive and false-negative findings, including missed scaphoid fractures [44]. The combination of conventional radiographs and clinical reassessment does not increase diagnostic accuracy compared with radiographs alone [8]. The incidence of true scaphoid fractures in patients with suspected injury is variable but typically low, within the 10%-20% range [44]. Most patients with suspected scaphoid fractures will not have a scaphoid fracture [44].

Early MRI: Provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive, which is cost-effective and minimizes complications [29]. Early MRI accurately and reliably identifies a significant number of radiological occult injuries and early identifies patients without acute injuries [11]. Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture [17]. There is a need for a consensus definition of scaphoid fractures on MRI scans to assess reliability, diagnostic performance, potential harms, and benefits [9]. CT: A good way to screen occult fractures but may not be any better than MRI or bone scanning in detecting scaphoid fractures without some overtreatment [32]. CT scans reformatted along the long axis of the scaphoid have better diagnostic performance for true fractures than CT scans reformatted relative to the anatomical planes of the wrist [47]. The use of CT to exclude or confirm a scaphoid fracture raises questions regarding under- or overdiagnosis in daily practice [26]. Ultrasonic assessment: Not recommended for early diagnosis of acute scaphoid fractures due to a sensitivity of only 50% and five missed scaphoid fractures in a small series [20]. HRpQCT: Diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture [21].

There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced' [4]. True scaphoid waist fractures are uncommon among patients with suspected scaphoid fractures [18]. Despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures [6]. MRI-detected scaphoid fractures are not universally benign; delayed or nonunion is seen in over 6% despite appropriate initial immobilization, with most of these patients requiring surgery to achieve union [22]. An undiagnosed and untreated scaphoid fracture can lead to significant clinical complications, such as non-union, avascular necrosis, and secondary wrist arthritis [44]. Until methods of diagnosing fracture union are better defined and improved for accuracy and precision, caution is warranted in the reporting and interpretation of time to union of any fracture or nonunion, the scaphoid in particular [25].

Pediatric Considerations: The scaphoid experiences a period of maturation from age 6 to 15 years, altering its physical properties during this time [30]. Patient age, degree of ossification, and fracture location are interrelated factors important for determining fracture type, classification, and treatment in pediatric patients [30]. D’Arienzo proposed a three-part classification system for pediatric scaphoid fractures based on the age of the child and the presumed degree of ossification [30]. Type 1: Occur in children younger than age 8 years and may be purely chondral or involve part of the ossific nucleus; these are more rare and difficult to diagnose, often requiring advanced imaging modalities such as magnetic resonance imaging (MRI) [30]. Type 2: Osteochondral fractures occurring in patients aged 8 to 11 years [30]. Type 3: The most common fractures occurring in adolescents aged ≥12 years; at age ≥12 years, the scaphoid is almost completely ossified, and these fractures behave similarly to those in the adult population [30]. Pediatric scaphoid fractures may be classified according to anatomic location: tuberosity, transverse distal pole, avulsion distal pole, waist, and proximal pole [30]. In children, fractures of the distal third of the scaphoid are the most common [30].

Current management decisions are often based on small case series, with many well-established principles supported by insufficient evidence [3]. High rates of delayed presentation and incomplete evaluation and treatment suggest a strong need for better patient and doctor education on the subject of scaphoid injuries and nonunions [27]. Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data [28].

Investigations

Plain radiography: Conventional radiographs combined with two clinical examinations provide inadequate diagnostic certainty for scaphoid fractures, identifying a true fracture in only about 40% of patients [2]. The combination of conventional radiographs and clinical reassessment does not increase diagnostic accuracy compared to conventional radiographs alone [8].

MRI: MRI is regarded as the best diagnostic radiological test for triage of suspected scaphoid fractures, with bone scanning, CT, and ultrasound serving as useful alternatives when MRI is unavailable [60]. Early MRI in patients with clinically suspected scaphoid fractures accurately and reliably identifies a significant number of radiological occult injuries [11]. Early MRI allows for the early identification of patients without acute injuries [11]. Clinical examination combined with early MRI scan should form the basis for diagnosing suspected scaphoid fractures [17]. However, routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment [62]. Nearly 70% of MRI findings in suspected scaphoid fractures are categorized as distracting and potentially misleading [62]. Stopping the pursuit of occult fractures may prevent unnecessary treatment due to the high prevalence of distracting signal changes and low prevalence of true fractures in routine MRI [77]. MRI is not 100% specific for diagnosing occult scaphoid fractures, with a specificity of 96% observed in healthy volunteers [68]. Better standardization of MRI definitions for scaphoid fractures is required, though diagnostic uncertainty may be unsolvable, suggesting patient participation in diagnostic and treatment decisions [67]. MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion occurring in over 6% of cases despite appropriate initial immobilization [22]. Most patients with nonunion of MRI-detected scaphoid fractures require surgery to achieve union [22]. Clinical scaphoid fractures in children are associated with a low but non-zero occult fracture rate, radiologic interpretation discordance, and the lack of advanced imaging [74].

CT: Computed tomography improves the reliability of detecting scaphoid fracture displacement but has a limited effect on accuracy, which remains below 80% [79]. Interobserver variability among radiologists using CT raises concerns about potential under- or overdiagnosis of scaphoid fractures in daily practice [26]. CT is considered a good method for screening occult fractures but may not be superior to MRI or bone scanning in detecting scaphoid fractures without risking overtreatment [32]. Three-dimensional imaging should be considered when assessing scaphoid nonunions to identify the exact location of the fracture [36].

Bone scan: Bone scanning serves as a useful alternative to MRI when MRI is unavailable [60].

Ultrasound: Ultrasonic assessment is not recommended for the early diagnosis of acute scaphoid fractures due to a sensitivity of only 50% and missed fractures in reported series [20].

Other Considerations: There is no consensus on the imaging modality or measurements used to define a scaphoid fracture as nondisplaced [4].

Treatment

Non-Operative

There is insufficient evidence to support a single most effective treatment for acute scaphoid fractures [52]. Among patients managed nonoperatively, the prescription of NSAIDs within 1 month of diagnosis is associated with an increased risk of nonunion and subsequent salvage procedures [57].

Operative

Indications: Appropriately performed acute percutaneous internal fixation is a standard treatment option for selected patients with acute scaphoid fractures [5]. Early internal fixation is increasingly favored even for nondisplaced fractures [6]. Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favorable compared to conservative treatment for standardized functional outcomes in the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks) [19]. However, there is no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively [12]. One study did not demonstrate a true long-term benefit of internal fixation compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [7].

Surgical Approach / Technique: The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period [10]. Despite improvements in diagnosis and surgical techniques, nonunion rates remain high [6].

Scaphoid Nonunion Treatment

Uncomplicated scaphoid nonunions that are nondisplaced and nonangulated are candidates for minimally invasive bone grafting and compression screw fixation [58]. The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective [46]. The procedure using double antirotation screw fixation performed with arthroscopy is considered pertinent for certain recent scaphoid nonunions [16]. Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection [31].

Adjuncts: The decision regarding the use of vascularized bone grafting or nonvascularized bone grafting for scaphoid nonunion needs guidelines based on patient- and fracture-specific risk factors, as avascular necrosis is not the sole determinant and its detection lacks consensus [71].

Other Considerations

This report documents the first case of spontaneous healing of an established proximal pole scaphoid non-union without surgical intervention or immobilization [59]. In contrast, a child, one of the youngest patients described in the literature with a scaphoid fracture, went on to non-union despite immediate medical attention and rigorous treatment [51].

Complications

Nonunion and Malunion: There is no true long-term benefit of internal fixation compared with nonoperative treatment for acute nondisplaced or minimally displaced scaphoid fractures [7]. Virtually all scaphoid fractures which unite have a good outcome, regardless of malunion [15]. Scaphoid nonunion is associated with progressive degenerative changes, although the correlation of symptoms and disease is poor and the true natural history is debatable [23]. Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful [34]. Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast [37]. Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union [40].

Other Considerations: Misdiagnosed and maltreated scaphoid fractures result in significant complications, primarily pseudoarthrosis, and high costs for both society and patients [65]. Young males and persons between 10 and 19 years of age are at highest risk for scaphoid fracture [38]. There was an increased incidence of scaphoid fracture surgery between 1997 and 2014, occurring especially in the primary fracture fixation group and particularly in the two youngest age groups [76].

Recovery

Light activity (weeks): Patients with distal scaphoid fractures report normal self-assessed hand function, good wrist motion, and strength at 8- to 11-year follow-up [14]. Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures results in a significantly faster return to work, with a standardised mean difference of 7 weeks compared to conservative treatment [19].

Full activity (months): Good clinical outcomes can be achieved after scaphoid fractures in prospective NFL athletes [70]. Arthroscopic-assisted percutaneous screw fixation of displaced fractures of the scaphoid achieves good to excellent function predictably without the need for open exposure [88].

Complete recovery / outcome plateau (months): Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years) [19]. Scaphoid nonunions demonstrate findings indicative of progression to union on CT as early as 3 weeks postoperatively, with findings indicative of progression to union on CT at a mean of 6 weeks postoperatively [85].

Rehabilitation protocol: The frequency of nonunion after surgical management for closed scaphoid fractures exceeds 10% [10]. Persistent nonunion is common after surgery for scaphoid non-union [34]. Surgeries for persistent nonunion are even less successful [35].

Functional milestones: Capitate-capitate (CC) grafts are associated with consistent deformity correction and superior Mayo wrist scores in the management of unstable scaphoid nonunion [39]. Distal scaphoid resection is a durable procedure with good long-term results for arthritis secondary to scaphoid nonunion [73]. 94% of patients remained satisfied after distal scaphoid resection for arthritis secondary to scaphoid nonunion [73]. No further wrist collapse or radiocarpal arthritis developed after distal scaphoid resection for arthritis secondary to scaphoid nonunion [73].

Other Considerations: Early MRI in patients with clinically suspected scaphoid fracture accurately and reliably identifies a significant number of radiological occult injuries [11]. Early MRI in patients with clinically suspected scaphoid fracture allows for early identification of patients without acute injuries [11]. Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure [37]. The union rate remains high with comparable time in cast despite delayed presentation of scaphoid fractures 21 days or more after injury [37]. High rates of delayed presentation and incomplete evaluation and treatment contribute to nonunion [27]. Patients from socioeconomically deprived communities experienced significantly longer delays in presentation for scaphoid fractures [86]. Patients from socioeconomically deprived communities experienced a higher incidence of nonunion [86]. Longer delays in presentation and higher incidence of nonunion in socioeconomically deprived communities may increase the risk of long-term complications such as scaphoid nonunion advanced collapse and wrist arthritis [86]. Scaphoid nonunion is associated with progressive degenerative changes [23]. The correlation of symptoms and disease in scaphoid nonunion is poor [23]. The true natural history of scaphoid nonunion is debatable [23]. The development of avascular necrosis (AVN) corresponds with a worse prognosis and increases the likelihood of secondary procedures [87]. AVN only correlates with nonunion in the scaphoid among proximal femur, proximal humerus, talar neck, and scaphoid fractures [87].

Key Evidence

  • [L1] Pediatric scaphoid fractures have excellent outcomes. [1] (10.1177/1558944717735948)
  • [L5] The combination of conventional radiographs and two clinical examinations does not provide adequate diagnostic certainty for scaphoid fractures, as a true fracture was identified in only about 40% of patients. [2] (10.1097/corr.0000000000002413)
  • [L5] Even some well-established and widely used principles of scaphoid fracture management are supported by an insufficient amount of evidence, with many decisions based on small case series. [3] (10.1177/1753193420977241)
  • [L5] There is no consensus regarding the imaging modality and measurements to use to define a scaphoid fracture as 'nondisplaced.' [4] (10.1016/j.jhsa.2012.10.025)
  • [L4] Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture. [5] (10.5435/00124635-200708000-00004)
  • [L5] This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions, highlighting that despite improvements in diagnosis and surgical techniques, nonunion rates remain high and early internal fixation is increasingly favored even for nondisplaced fractures. [6] (10.1016/j.jhsa.2008.04.026)
  • [L1] This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. [7] (10.2106/jbjs.g.00673)
  • [L2] The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures. [8] (10.1097/corr.0000000000002310)
  • [L3] This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits. [9] (10.1177/17531934251367541)
  • [L3] The frequency of non-union after surgical management for closed scaphoid fractures exceeds 10% and remained consistent during the study period. [10] (10.1016/j.jhsa.2015.06.019)
  • [L2] The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries. [11] (10.1177/1753193412471008)
  • [L1] We found no difference in functional outcome at 12 months for fractures of the waist of the scaphoid with ≤ 2 mm displacement treated operatively or nonoperatively. [12] (10.1302/0301-620x.104b8.bjj-2022-0085.r2)
  • [L4] Residual scaphoid deformity has no relevant negative impact on mid-term wrist function. [13] (10.1177/17531934221125355)
  • [L2] From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. [14] (10.1016/j.jhsa.2017.06.016)
  • [L3] Virtually all scaphoid fractures which unite have a good outcome, regardless of malunion. [15] (10.1177/1753193408093327)
  • [L4] The procedure is considered pertinent for certain recent scaphoid nonunions. [16] (10.1016/j.jhsa.2014.06.089)
  • [L3] Clinical examination along with early MRI scan should form the basis of diagnosing a suspected scaphoid fracture. [17] (10.1177/1753193420979465)
  • [L2] True scaphoid waist fractures are uncommon among patients with suspected scaphoid fractures. [18] (10.1007/s11552-007-9077-8)
  • [L1] Surgical treatment for non-displaced and minimally displaced acute scaphoid fractures may be slightly favourable compared to conservative treatment for standardised functional outcome on the short term (within 2 years), with a significantly faster return to work (SMD of 7 weeks). [19] (10.1136/jisakos-2015-000024)
  • [L4] With a sensitivity of only 50% and five missed scaphoid fractures in this small series, we can not recommend ultrasonic assessment for the early diagnosis of acute scaphoid fractures. [20] (10.1054/jhsb.2000.0432)
  • [L4] The diagnosis of scaphoid and other fractures is reliable when using HRpQCT in patients with a clinically-suspected fracture. [21] (10.1302/0301-620x.102b4.bjj-2019-0632.r3)
  • [L3] MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. [22] (10.1302/0301-620x.106b4.bjj-2023-1171.r1)
  • [L5] Scaphoid nonunion is associated with progressive degenerative changes, although the correlation of symptoms and disease is poor and the true natural history is debatable. [23] (10.1016/j.jhsa.2012.03.002)
  • [L1] Nondisplaced scaphoid fractures can be effectively treated nonoperatively with union rates approaching or exceeding those of operative intervention, while operative intervention is recommended for displaced fractures. [24] (10.2106/jbjs.rvw.15.00073)
  • [L5] Until methods of diagnosing fracture union are better defined and improved for accuracy and precision, caution is warranted in the reporting and interpretation of time to union of any fracture or nonunion, the scaphoid in particular. [25] (10.1016/j.jhsa.2008.03.014)
  • [L1] This finding raises the question as to whether scaphoid fractures could be under- or overdiagnosed in daily practice when CT is used to exclude or confirm a fracture. [26] (10.1016/j.jhsa.2012.08.016)
  • [L2] The high rates of delayed presentation and incomplete evaluation and treatment suggest a strong need for better patient and doctor education on the subject of scaphoid injuries and nonunions. [27] (10.1016/j.jhsa.2011.06.016)
  • [L5] Scaphoid fracture and nonunion management continues to be an area of expanding evidence with opportunities to improve knowledge and familiarization with current evidence-based data. [28] (10.1016/j.jhsg.2024.06.013)
  • [L5] Early magnetic resonance imaging (MRI) provides an immediate diagnosis for suspected scaphoid fractures when initial radiographs are inconclusive, which is cost-effective and minimizes complications. [29] (10.1016/j.jhsa.2013.03.055)
  • [L5] [30] (10.5435/00124635-200902000-00004)
  • [L4] Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection. [31] (10.1016/j.jhsg.2024.03.013)
  • [Commentary] CT is a good way to screen occult fractures but may not be any better than MRI or bone scanning in detecting scaphoid fractures without some over treatment. [32] (10.1177/1753193412446273)
  • [L4] The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. [33] (10.1177/15589447221093675)
  • [L4] Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful. [34] (10.1016/j.jhsa.2015.06.022)
  • [L4] Persistent nonunion is common after surgery for scaphoid non-union, and surgeries for persistent nonunion are even less successful. [35] (10.1016/j.jhsa.2015.06.023)
  • [L4] Three-dimensional imaging should be considered when assessing scaphoid nonunions to identify the exact location of the fracture. [36] (10.1016/j.jhsa.2008.05.035)
  • [L4] Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast. [37] (10.1016/j.jhsa.2023.10.020)
  • [L4] Young males and persons between 10 and 19 years of age are at highest risk for scaphoid fracture. [38] (10.1016/j.jhsa.2010.05.017)
  • [L1] CC grafts are associated with consistent deformity correction and superior Mayo wrist scores. [39] (10.1016/j.jhsa.2014.05.009)
  • [L3] Patients with comorbid psychiatric conditions experienced increased rates of delayed scaphoid union. [40] (10.1177/15589447221142894)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [41] (10.1016/j.jhsa.2008.03.008)
  • [L1] [44] (10.1177/1753193417742553)
  • [L4] The use of 2 headless compression screws for the treatment of scaphoid nonunions is safe and effective. [46] (10.1016/j.jhsa.2014.02.030)
  • [L2] [47] (10.1007/s11552-013-9556-z)
  • [L4] SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability. [48] (10.1186/s12891-025-08652-6)
  • [L4] However, the scaphoid motion during forearm and thumb motion was not significant. [50] (10.1016/j.jhsa.2017.03.008)
  • [L4] This case is interesting as the child is one of the youngest patients described in the literature with a scaphoid fracture, and the fracture went on to non-union despite immediate medical attention and rigorous treatment. [51] (10.2106/00004623-198365080-00026)
  • [L1] Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures. [52] (10.1007/s11552-010-9276-6)
  • [L4] This technique provides a large graft with a long vascular pedicle to restore normal scaphoid geometry and permit normal carpal kinematics. [53] (10.1016/j.jhsa.2010.10.015)
  • [L5] The authors state that biomechanical studies demonstrate osteotomies can reliably shift load away from the scaphoid and lunate, and that the procedure involves limited dissection to protect wrist joint innervation, contrasting with denervation procedures requiring extensive dissection. [54] (10.1016/j.jhsa.2014.05.037)
  • [L2] Among patients with nonoperatively managed scaphoid fractures, those prescribed NSAIDs within 1 month of diagnosis demonstrated an increased risk of nonunion and subsequent salvage procedures. [57] (10.1016/j.jhsg.2026.100958)
  • [L4] Uncomplicated scaphoid nonunions that are nondisplaced and nonangulated are candidates for the minimally invasive bone grafting and compression screw fixation procedure described. [58] (10.1016/j.jhsa.2008.03.004)
  • [L4] This report documents the first case of spontaneous healing of an established proximal pole scaphoid non-union without surgical intervention or immobilization. [59] (10.1007/s11552-011-9328-6)
  • [L5] According to the existing literature, MRI is the best diagnostic radiological test for triage of suspected scaphoid fractures, but bone scanning, CT, and ultrasound may also be useful, particularly when MRI is not readily available. [60] (10.1016/j.jhsa.2008.04.016)
  • [L5] Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment, with nearly 70% of MRI findings categorized as distracting and potentially misleading, suggesting that stopping the pursuit of occult fractures may prevent unnecessary treatment. [62] (10.1097/corr.0000000000002914)
  • [L3] By contrast, radiocarpal-based lunate morphology was not associated with scaphoid fracture. [64] (10.1016/j.jhsa.2025.10.018)
  • [L3] Misdiagnosed and maltreated scaphoid fractures result in significant complications, primarily pseudoarthrosis, and high costs for both society and patients. [65] (10.1530/eor-21-0108)
  • [L4] This review focuses on the indications and role of bone grafts in scaphoid nonunions to help augment internal fixation, promote healing, and restore carpal alignment. [66] (10.5435/jaaos-d-24-00510)
  • [L5] The authors argue that better standardization of MRI definitions for scaphoid fractures is required, but acknowledge that a definition may not exist to solve the potentially unsolvable issue of diagnostic uncertainty, suggesting patients should participate in decisions regarding diagnostic and treatment strategies. [67] (10.1177/17531934251394819)
  • [Paper] MRI is not 100% specific for diagnosing an occult scaphoid fracture, with a specificity of 96% in healthy volunteers. [68] (10.1016/s0363-5023(10)60085-8)
  • [L4] The patient may represent two isolated coexisting conditions, or the anomalous carpal kinematics caused by the lunotriquetral coalition may have predisposed both scaphoid bones to fracture, although causality cannot be proven. [69] (10.1016/j.jhsa.2015.07.003)
  • [L4] Good clinical outcomes can be achieved after scaphoid fractures in prospective NFL athletes. [70] (10.1016/j.arthro.2017.08.259)
  • [L5] The decision regarding the use of vascularized bone grafting or nonvascularized bone grafting for scaphoid nonunion needs guidelines based on patient- and fracture-specific risk factors, as avascular necrosis is not the sole determinant and its detection lacks consensus. [71] (10.1016/j.jhsa.2021.05.014)
  • [L4] Radiographic classification of SLAC wrist has moderate reliability and reproducibility, whereas classification of SNAC wrist has limited reliability. [72] (10.1177/1753193413484629)
  • [L4] Distal scaphoid resection is a durable procedure with good long-term results. 94% of patients remained satisfied, and no further wrist collapse or radiocarpal arthritis developed. [73] (10.1016/s0363-5023(11)60002-6)
  • [L4] Findings suggest a low but non-zero occult scaphoid fracture rate, discordance in radiologic interpretation, and a lack of advanced imaging, providing an avenue for future prospective studies. [74] (10.1177/1558944720930293)
  • [L3] The main finding of our study was an increased incidence of scaphoid fracture surgery between 1997 and 2014, occurring especially in the primary fracture fixation group and particularly in the two youngest age groups. [76] (10.1177/1753193417726051)
  • [L4] Routine MRI of suspected scaphoid fractures carries a notable risk of overdiagnosis and potential overtreatment due to the high prevalence of distracting signal changes and low prevalence of true fractures. [77] (10.1097/corr.0000000000002851)
  • [L3] Computed tomography improves the reliability of detecting scaphoid fracture displacement but has a more limited effect on accuracy, which remains <80%. [79] (10.2106/JBJS.E.01211)
  • [L5] [82] (10.1097/01.blo.0000205886.66081.9d)
  • [L3] [83] (10.1177/1753193417739519)
  • [L4] Scaphoid nonunions demonstrate findings indicative of progression to union on CT at a mean of 6 weeks and as early as 3 weeks postoperatively. [85] (10.1016/j.jhsa.2016.07.051)
  • [L3] Patients from socioeconomically deprived communities experienced significantly longer delays in presentation for scaphoid fractures and a higher incidence of nonunion, which may increase the risk of long-term complications such as scaphoid nonunion advanced collapse and wrist arthritis. [86] (10.1016/j.jhsg.2025.100932)
  • [L4] The development of AVN corresponds with a worse prognosis and increases the likelihood of secondary procedures, though it only correlates with nonunion in the scaphoid. [87] (10.5435/jaaos-d-18-00225)
  • [L4] The early results of arthroscopic-assisted percutaneous screw fixation of displaced fractures of the scaphoid suggest that union can be obtained and good to excellent function achieved predictably without the need for open exposure. [88] (10.1177/1753193408090121)

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