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Background: Fractures of the scaphoid bone are common but can easily be overlooked in standard X‑rays. Inadequate diagnostics and therefore inappropriate treatment of scaphoid fractures often leads to problems in healing with formation of non-union and painful osteoarthritis of the wrist., Objective: This review summarizes the current practical recommendations in the diagnostics and treatment of acute scaphoid fractures., Methods: An analysis and review of selected literature including the current S3 guidelines were performed., Results: The main statements are that in cases of a clinically suspected scaphoid fracture, staged diagnostics including radiographs, computed tomography (CT) and when necessary magnetic resonance imaging (MRI) should be applied to confirm or exclude a fracture. Further treatment in the case of a fracture is planned according to a CT-based classification. There are fracture types that can be treated either conservatively or operatively and there are other fracture types that always require operative fixation. The operative technique depends on the exact fracture geometry. For osteosynthesis, cannulated headless compression screws are mostly used.

The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.

With the exception of the relatively frequent fractures of the scaphoid bone, isolated fractures of individual carpal bones are rare. Because these injuries are uncommon and because of the complex anatomy and function of the carpus, treatment of carpal bone fractures can be challenging. Carpal bone fractures generally occur in young, sports active and professional patients, can be easily overlooked in plain radiographs and are frequently associated with ligamentous instability, neurovascular injuries and tendon lesions. Small posttraumatic alterations of the precisely aligned carpal structure can cause chronic pain and functional impairment. Therefore, if a wrist fracture is suspected a thorough clinical examination and appropriate differentiated imaging is always necessary, at the end of which a fracture can be excluded or an appropriate conservative or surgical treatment is initiated, with the aim of restoration of carpal anatomy and function.