The vascular supply of the carpus is provided by the radial, ulnar, and anterior interosseous arteries. At the level of the carpus, these arteries contribute to a dorsal and palmar carpal vascular system, each of which consists of a series of transverse vascular arches interconnected by longitudinal anastomoses. The internal vascularity of the scaphoid, capitate, lunate, and the hook of the hamate is relatively limited and places these bones at risk for osteonecrosis. The increased risk is consistent with the clinical incidence of osteonecrosis of these bones. Osteonecrosis can lead to bone collapse and secondary arthrosis. Treatment depends on the stage of the process. In the early stages, several treatment options are available and are directed toward protection, grafting, biomechanical correction, or revascularization. In later stages, if carpal arthrosis develops, salvage procedures such as arthrodesis, resection, or arthroplasty are used.