Snapshot A 28-year-old man trips while running and lands on his outstretched left hand. He experiences immediate-onset, severe left wrist pain and inability to flex or extend his wrist. On exam, he has point tenderness dorsally over the anatomic snuffbox. A radiograph of his left wrist demonstrates a fracture of the proximal pole of the scaphoid. Introduction Clinical definition fracture of the scaphoid bone login to view 1 more bullet Epidemiology Incidence most common carpal fracture Demographics adolescents and young adults more common in males than females Etiology Fall from standing height on an outstretched hand High-energy trauma is less common Pathoanatomy normal anatomy login to view 15 more bullets fracture location login to view 4 more bullets Associated conditions ligamentous injury (wrist sprain) login to view 1 more bullet Presentation Symptoms radial wrist pain Physical exam anatomic snuffbox tenderness dorsally scaphoid tubercle tenderness volarly pain with resisted pronation Imaging Radiography indications login to view 5 more bullets findings login to view 1 more bullet Computerized tomography (CT) indications login to view 3 more bullets findings login to view 1 more bullet Magnetic resonance imaging (MRI) indications login to view 2 more bullets findings login to view 2 more bullets Differential Distal radius fracture fracture will be evident on an AP and/or lateral radiograph of the wrist more likely in older patients Wrist sprain ligamentous injury in the absence of a fracture will be evident on MRI Treatment Non-operative thumb spica cast immobilization login to view 3 more bullets Operative percutaneous pin fixation vs open reduction and internal fixation (ORIF) login to view 6 more bullets Complications Avascular necrosis most common in proximal injuries due to a retrograde blood supply Non-union Scaphoid non-union advanced collapse (SNAC) progressive wrist arthritis due to chronic scaphoid non-union Prognosis Favorable stable non-displaced fracture Unfavorable unstable displaced fracture AVN