[Palmarly comminuted scaphoid fractures]

Two cases of acute scaphoid fractures of the middle third with palmar comminution were treated with cancellous bone transplantation and Herbert screw fixation. Despite 6 weeks of cast immobilization, secondary loss of reduction resulted in primary grade dislocation in one patient. In the other patient scaphoid dislocation led to dorsiflexed intercalated segment instability and the need for screw removal due to secondary joint irritation. As a consequence the authors recommend the use of cortical bone grafting of the iliac crest in cases where palmar defects occur after reduction of the scaphoid.