The Treatment of Scaphoid Fractures Using Free-Hand Insertion of a Herbert Screw

Abstract

Surgical techniques and clinical indications for free-hand Herbert-screw insertion for scaphoid fractures are described. Eleven patients were treated by this method. The fractures included 3 of the acute stable type, 4 of the acute unstable type, and 4 of delayed union. Three cases were complicated by fractures of the distal radius and one by the fracture of the proximal radial head. In 1 case, bony fusion was not achieved due to malalignment: an additional bone graft was performed, and a good bony union was achieved. In the other 10 cases, a solid union and good clinical results were achieved. This method is recommended for acute stable scaphoid fracture complicated by concomitant fractures requiring early mobilization, patients with acute stable fractures who wish to avoid long-term external fixation, acute unstable fractures in which trial reduction is perfect, cases of delayed union not requiring bone graft, and when the fracture is in the small proximal pole.