Diagnosis and proper initial management of acute fractures of the carpal bones is critical because of the limited blood supply of many bones of the wrist and the role of the carpus in optimizing hand function. Pathology is correctly diagnosed by a focused history and examination. Injuries may be missed with a cursory examination and routine wrist radiographs. Together, fractures of the scaphoid and triquetrum make up nearly 90% of carpal bone fractures. Relative frequency, mechanism of injury, diagnosis, and management principles are covered for each of the bones of the wrist.