The scaphoid bridges the proximal and distal carpal rows, making it the mechanical pivot of wrist motion and uniquely vulnerable to fracture from a fall on the outstretched hand. Its blood supply enters exclusively through its distal pole (from the radial artery via the dorsal scaphoid branch), making the proximal pole avascular — proximal pole fractures have a 30-40% AVN rate. The waist is the most common fracture site (70%).
Anatomical snuffbox tenderness after FOOSH requires scaphoid fracture protocol: plain X-ray (misses 20-30%), CT or MRI within 72 hours if X-ray negative. Waist fractures in young patients are fixed with a headless compression screw (percutaneous or open). Proximal pole fractures and delayed presentations (>4 weeks) require ORIF with bone grafting. Non-union produces SNAC wrist arthritis.
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