1. If you have wrist pain after a fall, see a doctor
Both fractures and sprains can cause pain and swelling. However, if the pain is localized on the thumb side of the wrist and there is tenderness and swelling in the snuffbox, and it doesn't seem to be getting better, you may have a scaphoid fracture. Sometimes scaphoid fractures don't hurt or swell that much at all, and people delay seeking out medical treatment for weeks. This can have adverse effects on the healing of a scaphoid fracture.
2. X-rays should be taken
Initially, X-rays should be taken to see if there is an obvious fracture. Sometimes, the X-ray will appear normal, but the doctor may put you in a splint or cast for a few weeks, especially if you have snuffbox tenderness. The reason is that sometimes, it takes a few weeks in order to actually see the fracture on X-ray. If the X-ray is inconclusive, an MRI or CT scan may be ordered to see if there is a fracture. These tests are more sensitive in visualizing a fracture, and they can often identify a fracture sooner than an X-ray.
3. Some fractures should heal without surgery
Remember that the blood supply of the scaphoid bone is different. It gets its blood supply from the part of the bone away from the heart. Therefore, distal pole fractures (toward the thumb) have a higher rate of healing. Non-displaced fractures also have a higher chance of healing because the blood supply may not be disrupted. These fractures may be treated in a cast. The cast may be short (below the elbow) or long (above the elbow). It may or may not include the thumb (a thumb spica cast). The cast may need to be worn for variable amounts of time, up to 3 to 6 months in some cases. Even then, it still may not heal, again because of the poor blood supply.
4. Some fractures will need surgery
If the fracture is displaced (shifted) or the doctor feels that the bone may not heal in a cast, then surgery may be a better option. Pins or screws can be placed across the fracture to stabilize it while it is healing. This may be done through a small hole in the skin (percutaneous). Other times, an open reduction may be necessary, which involves an incision to view the fracture and align the bones. The incision may be in the palm or the back of the hand, depending on the site of the fracture.
5. Even with surgery, it may not heal
Due to the blood supply, this is a hard fracture to heal. The bone may not heal at all (non-union). It may not heal in proper alignment (malunion). Part of the bone may die (avascular necrosis). When these things occur, the mechanics of the wrist are altered, which can lead to early arthritis. So you can see, despite it being a small bone (only 2 to 3 cm from end to end), it is a very important bone of the wrist and a bad one to break.
