Scaphoid fracture as a "puncher's fracture"

We investigated 18 scaphoid fractures induced by punching. The wrist position while punching was neutral to slight palmar flexion. We postulated that the mechanism of the fracture was caused by the concentration of the external force to the second metacarpus. The forces are then dispersed to the trapezium and trapezoid, which produces shear stress at the waist of the scaphoid. In spite of the differences in mechanism, the location of the fracture was similar to fractured scaphoids caused by wrist extension injuries. Regardless of the wrist positions, the carpal scaphoid is most vulnerable to fracture due to its characteristic morphology.