Overview
The scaphoid is a small wrist bone with a tenuous blood supply that enters from the distal end. A fracture — especially one through the middle (waist) or proximal pole — can cut off the blood supply to the proximal fragment and lead to nonunion or avascular necrosis.
Operative fixation is considered for displaced fractures, proximal-pole fractures, and fractures in active patients or athletes who want a shorter immobilization period. Cast treatment remains an option for non-displaced distal fractures, but the healing timeline can run long.
Why it's done
Scaphoid fixation is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Displaced fracture
Any displacement raises the nonunion rate significantly.
Proximal-pole fracture
Poor blood supply demands stable fixation.
Delayed presentation
A fracture that hasn't started to heal within a few weeks.
Active or athletic patient
To shorten immobilization and return to sport.
Nonunion from prior non-operative care
Requires fixation plus bone graft.
How it works
A headless compression screw is placed down the long axis of the scaphoid under fluoroscopic guidance. The approach can be either from the palm side (volar) or the back side (dorsal), depending on the fracture location.
For nonunion or avascular necrosis, a vascularized or non-vascularized bone graft is combined with the screw. Small incisions and percutaneous techniques are used when possible.
Recovery
The wrist is splinted for comfort early on and then transitioned to a removable brace. Hand-therapy motion exercises begin once the wound is healed. Return to sports typically requires radiographic evidence of healing, often confirmed with a CT scan at follow-up. Return to work depends on demands. The screw is left in place unless symptomatic.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a non-union — the scaphoid has poor blood supply and an unfixed displaced fracture frequently fails to heal, which leads to a predictable pattern of wrist arthritis. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before scaphoid fixation include:
- bleeding and infection
- anesthesia risk
- non-union despite fixation, particularly in proximal-pole patterns
- avascular necrosis of the proximal fragment
- hardware irritation
- stiffness
- scar tenderness
The indication to proceed is a displaced scaphoid fracture, a proximal-pole fracture, or a patient who cannot tolerate prolonged casting. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: