[Alternative surgical procedure in pseudarthrosis of the scaphoid bone with a small proximal fragment]

The management of non-union of the scaphoid with a Herbert screw assumes a specific size of the proximal pole fragment. In cases of extremely small proximal pole fragments the length of the leading thread of the screw can cause blockage of the proximal pole fragment. In these instances a dorsal approach is used and the Herbert screw is inserted in a proximal-to-distal direction rather than the usual distal-to-proximal insertion. The advantages are a stable internal fixation and an abbreviated period of immobilization in plaster; however, the small number of cases reported does not permit us to draw conclusions regarding indications for use of this technique.