The scaphoid waist is the narrowest central portion of the scaphoid bone lying at the mid-carpal level, between the proximal pole (intraarticular) and the distal pole (extraarticular). The intraosseous blood supply enters the scaphoid primarily from its distal pole via vessels entering the dorsal ridge, meaning the proximal pole is supplied in a retrograde fashion. The waist is the most common fracture level (70% of scaphoid fractures).
Scaphoid waist fracture is the most common carpal bone fracture and a classic pitfall in wrist injury management because it may not be visible on initial radiographs. Missed scaphoid fractures proceed to non-union and avascular necrosis of the proximal pole (which has no direct blood supply at the waist level), ultimately causing carpal collapse (SNAC wrist). Non-displaced waist fractures are treated with cast immobilization or percutaneous screw fixation; displaced fractures require ORIF with a Herbert screw. Scaphoid non-union requires bone grafting and fixation.
Displaced scaphoid waist fracture disrupts the retrograde blood supply to the proximal pole, producing avascular necrosis with the characteristic dense proximal pole on radiograph; surgical treatment requires vascularised bone graft from the distal radius (Zaidemberg) or medial femoral condyle to restore vascularity alongside internal fixation.
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