Scaphoid fractures treated by Herbert screw fixation

Forty-one scaphoid fractures had Herbert screw fixation. There were three acutely displaced fractures (Type B), nine delayed unions (Type C), and 29 non-unions (Type D). All procedures were carried out by the senior author between December 1983 and May 1987. The average time from injury to surgery was 19 months. All Type D fractures were bone-grafted. Six of the 29 Type D fractures failed to unite radiologically following surgery. Incorrect screw placement was a factor in two cases. The average time from injury to surgery in three of the others was seven years. Radiological evidence of screw loosening was present within two months of mobilising these cases. We feel that Herbert screw fixation may not be adequate when dealing with longstanding scaphoid non-unions, and stronger fixation or prolonged cast immobilisation may be necessary.