Causes / typical injury mechanism: The scaphoid bone is the most commonly fractured carpal bone, accounting for two-thirds of all carpal fractures. The injury commonly occurs secondary to trauma, usually a fall on an outstretched hand, most often with a pronated, ulnarly deviated, and dorsiflexed wrist. Fracture can also occur with axial loading or direct blunt force.

Classic history and presentation: Patients will often present with radial-sided wrist pain and pain with resisted wrist extension such as with weightlifting or pull-ups / push-ups.

Prevalence:

• Age – This injury is most commonly seen in individuals between the ages of 21 and 30 years. The increased incidence in this age group is likely directly related to the increased risk associated with athletic participation.
• Sex / gender – Male patients experience this injury at higher rates than female patients. Previously, the ratio of male to female injury was thought to be close to 5:1, but more recent literature reports a ratio of 2:1. The increasing number of injuries in female patients is thought to be secondary to increased participation in sports and physical activities.

Risk factors: Risk factors include an active lifestyle, increased propensity to falls, and metabolic bone diseases such as osteoporosis.

Grade / classification system (if any): The most commonly used classification system is the Herbert classification.

• Type A: Stable fractures – scaphoid tubercle fractures and incomplete waist fractures
• Type B: Unstable fractures – comminuted fractures, fracture dislocations, oblique distal pole fractures, proximal pole fractures, and complete waist fractures
• Type C: Delayed unions
• Type D: Established nonunions