[Percutaneous Herbert screw osteosynthesis of the scaphoid bone]

Scaphoid fractures are the most common carpal fractures. Conservative treatment is long, and non-union is frequent after immobilization in a cast. The Herbert procedure is an improvement, but access to the scaphoid is through an extensive open exposure that damages the blood vessels and the anterior radiocarpal ligaments. In order to solve this problem we used the Herbert screw for percutaneous internal fixation resulting in minimal operative trauma. This procedure requires intraoperative x ray guidance and the use of the accessories of the Herbert set except the "Jick". We operated 23 patients for acute fracture (19 cases) or nonunion (4 cases) of the waist of the scaphoid. In this study, the average follow-up was 16 months and the average age was 32 years. There were 18 men and 5 women. In 18 cases the fracture occurred on the right side. The average immobilization was 15.5 days. Union was obtained in all patients. Postoperative range of motion was 95% of the unaffected side. Key pinch was 6% better than on the unaffected side (the dominant hand was affected in 81% cases). Patients returned to work after an average of 7 weeks.