Acute percutaneous scaphoid fixation using a non-cannulated Herbert screw

Conservative treatment of fractures of the scaphoid often leads to an important physical and economic morbidity, especially in the young and active population. Acute percutaneous scaphoid fixation is a fast technique with minimal soft tissue damage, which allows immediate mobilisation without prolonged casting. We describe our operation technique in which we always use a non-cannulated Herbert screw. We place the screw freehand and always pass through the trapezium, a technique which is in our hands the best way to place the screw in the right position. It is not technically demanding, but has a considerable learning curve and requires a three-dimensional knowledge of the scaphoid. We reviewed the results of 44 patients treated in our centre between 1996 and 2001. Comparing with literature of percutaneous scaphoid fixation, we found similar results. Although in literature this technique is only indicated for minimally and non-displaced fractures of the waist (Herbert A2 and B2), we describe some good results with proximal pole fractures. Nevertheless we found that all cases of delayed and non-union occurred with this type of fracture.