Diagnosis, classification, and treatment of scaphoid fractures

Herbert's classification of scaphoid fractures provides the underlying rati onale for treatment according to the fracture type. A CT bone scan in the l ong axis of the scaphoid is the best means of differentiating between stabl e and unstable fractures. This is difficult from conventional X-rays due to the particular three-dimensional anatomy of the scaphoid. To avoid long-te rm plaster immobilization and to diminish the risk of a non union, unstable fractures of type B should be fixed operatively. With headless screws such as the Herbert screw, which are now available in a cannulated shape, the majority of scaphoid fractures of type B1 and B2 ca n be stablized using minimally invasive procedures. Severely displaced frac tures require the classical open palmar approach. Proximal pole fractures ( B3) are best managed from the dorsal approach, using the Mini-Herbert screw . Stable fractures of type A2can be treated conservatively in a below-elbow cast or, alternatively, stabilized percutaneously, which allows early mobi lization.