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What is better (cast or surgery) if you break the bone at the bottom of the thumb, by the wrist? I know someone who had surgery and someone else who had a cast.

The bone at the base of the thumb, by the wrist, is called the scaphoid bone. It's a small bone that can be broken if you fall onto your outstretched hand. The treatment for the break depends on how severe the break is and if the bone was moved out of place. Usually, if the bone has moved and the broken ends don't meet each other, surgery is needed. If the bones aren't moved, doctors are torn as to which method is best.

Reference: 

Ruby Gerwal, MD, and Graham J.W. King, MD. An Evidence-Based Approach to the Management of Acute Scaphoid Fractures. In The Journal of Hand Surgery. April 2009. Vol. 34. No. 4. Pp. 732 to 734.

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