[Osteosynthesis for scaphoid fractures through a dorsal approach: one or two Herbert screws?]

The aim of this work is to show the merits of retrograde scaphoid fixation through a dorsal approach using two Herbert screws in both recent and old fractures, without the need for bone grafting. Fifty three scaphoid fractures were operated on by the author between 1992 and 2000, using a dorsal approach (mean follow-up 4 years). The time between trauma and surgery, the type of fracture, the mode of bone fixation, the time of immobilisation, and the clinical and radiological results were all been evaluated. All fractures but one united, in a mean time of 75 days. The time needed to achieve bone union increases with the delay in treatment, as does the time for clinical healing which may be as long as one year. The technique of retrograde scaphoid fixation with two Herbert screws is described, evaluated from the biomechanical point of view, and compared to other methods of fixation. In contrast to a single screw, two Herbert screws give complete stability of fixation, and guarantee a good clinical result provided the correct indications have been selected. This technique has advantages as an alternative procedure, especially in fractures that present after a significant delay, and enables one to avoid having to bone graft.