Procedures · Hand & Upper Extremity Surgery

Scaphoid Nonunion

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

The scaphoid is a small bone at the base of the thumb that works as a keystone between the two rows of wrist bones. It usually breaks in a fall onto the outstretched hand — and therein lies its double problem: the fracture can hurt so little that it is dismissed as a passing sprain, and parts of the bone have naturally poor blood supply. If diagnosis or treatment is missed, the fracture may never heal. That state is called nonunion.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

Why not simply leave it?

An un-united scaphoid does not stay a silent problem. Its two separated parts disturb the coordinated motion of the wrist's rows, the wrist begins moving on deranged hinges, and the cartilage starts wearing in a recognised pattern that advances over years from the fracture site to the rest of the joint. The earlier the reconstruction, the better the chance of sparing the wrist that course — once arthritis is advanced, the whole plan changes from saving the bone to salvaging what the wrist can keep.

When to suspect it

The typical story: an old fall onto the hand labelled a sprain, then recurring pain at the base of the thumb with use, weakened grip strength, and sometimes gradually increasing stiffness. Any persistent wrist pain after a fall — even weeks or months on — deserves imaging and assessment.

Assessment and investigations

X-rays open the assessment, showing the fracture, the nonunion, and any signs of arthritis. Where needed, CT defines the gap and deformity precisely, and MRI evaluates the blood supply of the proximal fragment — information that directly shapes the choice of graft. Not every investigation is needed in every case.

Reconstruction options

No single technique suits every nonunion; the plan is built on the fracture's site, the deformity, the bone's vitality, and the state of the cartilage:

• Fixation with bone grafting: clearing the nonunion site, filling it with bone graft, and fixing it with a screw or wires — the foundation in most cases.
• Structural grafting: a shaped graft that restores the scaphoid's length and form when it has collapsed or angulated.
• Vascularized bone grafting: a graft carried with its own living blood supply, in selected cases — particularly when the proximal fragment's circulation is poor.
• Salvage procedures: once arthritis has advanced, the plan turns to relieving pain and preserving useful function — from removing specific small bones to partial wrist fusion — with the options discussed frankly.

Recovery: bone will not be hurried

Scaphoid healing is slow by nature: cast or splint immobilisation for weeks, sometimes extending to months; imaging follow-up until union is confirmed; then graded rehabilitation of movement and grip strength. Desk work returns far earlier than sport or wrist-loading manual work, and individual instructions are the reference.

Limitations and risks

The foremost risk is persistent nonunion despite reconstruction — its likelihood rises with poor blood supply and with smoking — together with hardware problems, wrist stiffness, and continued progression of arthritis where it has already begun. Complete cessation of smoking is a practical requirement: its effect on bone healing is direct and well documented. The risks relevant to your case are discussed before any decision.

I was injured years ago and never treated — is it too late?

Not necessarily; the answer depends on the state of the cartilage more than the age of the fracture. Assessment and imaging determine whether reconstruction is still worthwhile or a salvage pathway serves better.

Why didn't the fracture show on the X-ray at the time?

Some scaphoid fractures are invisible on first X-rays and only declare themselves days later or on finer imaging — which is why pain at the base of the thumb after a fall is treated with caution even when X-rays look normal.

How long before I return to sport?

After union is confirmed on imaging and strength has returned — and the time varies widely between cases. The decision is made by imaging and examination, not by the calendar alone.

Medical-information notice

This is general information and does not replace consultation and examination. Persistent wrist pain after a fall deserves assessment and imaging without delay.