Scaphoid Fracture in Vienna
You fell on the outstretched hand, the wrist is swollen on the thumb side — and still you were told it was only a bruise. That is exactly how a missed scaphoid fracture begins. I clarify the suspicion quickly and discuss with you whether immobilisation is enough or whether screw fixation is the safer route.
In short
The scaphoid fracture is the fracture of a small carpal bone on the thumb side, usually after a fall on the bent-back hand. It shows itself through tenderness in the hollow at the root of the thumb, swelling and pain when leaning on the hand — often so mild that it is taken for a sprain. Because the fine fracture line frequently remains invisible on the first X-ray, I investigate further with MRI or CT when the mechanism of injury fits. Stable fractures can be immobilised; displaced ones I treat with percutaneous screw fixation, which often spares a cast.
What is a scaphoid fracture?
The scaphoid is one of eight small bones of the carpus. It lies on the thumb side and connects the two rows of the carpus like a strut. It therefore works with almost every movement of the wrist and carries the load when you lean on the hand. It breaks particularly often, usually in a fall on the hand bent backwards: cycling, snowboarding or in ball sports.
Two peculiarities make this fracture special. The scaphoid is covered with cartilage almost completely, and its blood vessels enter only at the end furthest from the body — a fracture higher up can impair the supply of the smaller fragment. And the pain often turns out weaker than expected. So the injury passes unnoticed into a non-union (pseudarthrosis, false joint), in which the fragments do not knit together in bone.
Typical symptoms
- Tenderness in the anatomical snuffbox — the hollow on the thumb side of the wrist
- Pain when leaning on the hand — when getting up or doing a press-up
- Loss of strength when gripping — opening bottles hurts
- Swelling on the thumb side — usually without a striking bruise
- Pain on compression — pressure along the axis of the thumb pulls in the wrist
- Symptoms that seem to fade — and come back under load
How I make the diagnosis
First I reconstruct the fall: how did the hand land, from what height? The mechanism of injury is the most important clue. The clinical examination follows, testing the snuffbox, the compression pain and mobility compared with the other side. In the practice I assess swelling, effusion and accompanying soft-tissue injuries with ultrasound. For the bone I arrange an X-ray in several planes. A normal X-ray does not rule out a scaphoid fracture: if the clinical suspicion remains, I arrange an MRI or a CT.
Treatment: conservative first
A stable, undisplaced fracture can heal without an operation. For that the wrist is immobilised in a splint or a cast that includes the thumb. The condition for it is close monitoring with images, to see whether the fracture is uniting and whether the position holds.
This immobilisation has its price, and I name it openly: the fingers become stiff, the forearm muscles waste, work and sport pause. So I discuss with you what speaks for and what speaks against this route. Alongside it I work with the physiotherapy and the exercise therapy that are available in the same building at the Orthozentrum Döbling.
When an operation is necessary
If the fracture is displaced, unstable or lies in the third closest to the body, I recommend screw fixation. With the percutaneous technique (through the skin) a small skin incision is enough: under X-ray control I place a guide wire and over it a double-threaded screw that draws the fragments together. The hand is then usually stable enough to exercise, and a cast is mostly unnecessary — an advantage if you work with your hands.
If an accompanying ligament injury of the wrist is suspected, I assess the joint in addition with an arthroscopy of the wrist and treat it at the same time. Where a non-union has already formed, I clear out the false joint through an open approach and fill it with your own bone graft. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on how a private practice works. Related conditions are the distal radius fracture at the wrist and wrist osteoarthritis; an overview is given by hand surgery in Vienna.
Whether immobilisation is enough or screw fixation the safer route, I do not decide on the telephone. I make that choice together with you, as soon as the findings are in.
Frequently asked
Frequently asked questions about the scaphoid fracture
The typical sign is tenderness in the anatomical snuffbox, the small hollow on the thumb side of the wrist. Swelling comes with it, pain when leaning on the hand and when gripping firmly, as well as a pulling sensation when the thumb is compressed along its axis. A striking bruise is often absent. Because the symptoms can stay mild, your own impression is no substitute for an examination.
The pain is less than one expects from a broken bone, and many take the injury for a sprain. In addition a fine fracture line often stays hidden on the first X-ray, because the carpal bones overlap one another. A normal X-ray does not rule out a scaphoid fracture; if the suspicion remains, I arrange an MRI or a CT.
No. Stable, undisplaced fractures can be immobilised; you then wear a splint or a cast that includes the thumb, and I follow the course with images. Displaced or unstable fractures should be fixed with a screw. Even with stable fractures, percutaneous screw fixation is one way to avoid the long immobilisation.
Through a small skin incision I place a guide wire into the scaphoid under X-ray control and insert a double-threaded screw over it. It draws the fragments together and sinks completely into the bone. The hand is then usually stable enough to exercise, and a cast is often unnecessary. The screw does not normally have to be removed.
One speaks of a non-union (pseudarthrosis, false joint) when the fragments do not knit together in bone. The cause is usually a missed fracture together with the delicate blood supply of the scaphoid. It makes itself felt through pain under load and loss of strength; in the long run osteoarthritis of the wrist can develop from it, the SNAC wrist. Treatment usually needs a bone graft.
That is decided by the course of healing, not by the calendar. What counts are the follow-up images, freedom from pain under load and the strength of the grip. Endurance training without weight-bearing through the hand is usually possible earlier than contact sport, climbing or weight training with support on the hand. I release the loading step by step.
Please bring everything you have: e-card, previous findings, doctors' letters and above all X-ray, CT or MRI images already taken. Older images help me for comparison as well. You do not need a referral. If the fall was recent, say so when you call: for acute cases I find times outside the regular consulting hours.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.