Scaphoid Fractures in Athletes: Diagnostic Pitfalls and Return-to-Sport Strategies - a narrative review

Abstract

Background. The scaphoid is the most frequently fractured carpal bone and is disproportionately common in athletes exposed to falls on an outstretched hand or direct impact to the wrist. Its retrograde, predominantly distal-to-proximal blood supply makes the fracture prone to diagnostic delay, nonunion, and avascular necrosis, while the athlete's imperative to return quickly to competition creates persistent tension between imaging accuracy, treatment choice, and timing of return to sport.Aim. To synthesise, critically and comparatively, the diagnostic pathway, treatment options, and return-to-sport considerations for scaphoid fractures in athletic populations, with emphasis on the medical rationale behind imaging strategies, operative versus conservative management, and their documented functional consequences.Materials and Methods. This narrative review draws on peer-reviewed epidemiological studies, cohort series, randomised controlled trials, systematic reviews and meta-analyses, diagnostic accuracy studies, artificial-intelligence validation studies, biomechanical studies, and international consensus statements.Results. Diagnostic accuracy varies substantially across radiography, CT, MRI, bone scintigraphy, ultrasound, cone-beam CT and artificial-intelligence-assisted reading, with important trade-offs in sensitivity, specificity, cost, and time to diagnosis. Surgical fixation generally accelerates radiographic union and return to sport relative to cast immobilisation, but the evidence for superior long-term functional outcomes is inconsistent, and nonunion, smoking status, and fracture displacement modify these effects.Conclusions. Optimal management of the athlete with a suspected or confirmed scaphoid fracture requires individualised integration of imaging accuracy, fracture stability, sport-specific demands, and rigorously defined return-to-sport criteria, rather than a uniform diagnostic or therapeutic algorithm.