Most suspected injuries to the carpal bones can be managed in the urgent setting with splinting and outpatient follow-up within to weeks Scaphoid fractures have different patterns depending on the age of the patient Younger patients have a significant incidence of fractures involving the distal third of the bone, although fractures in the middle third (i.e., the waist) are still the most common in children Adolescents and adults tend to fracture at the waist of the scaphoid A unique fracture to young patients is the avulsion of the distal radial aspect of the scaphoid This injury often is not diagnosed on first presentation and is seen on radiographs to weeks later In the emergency department, confirmed and suspected scaphoid fractures should be managed with a thumb spica splint or cast Most scaphoid fractures are nondisplaced and ultimately managed with cast immobilization, though displaced fractures may require surgical reduction and internal fixation to prevent nonunion In addition, those who present late with evidence of nonunion should be immobilized and referred to a hand specialist for possible surgical repair