Seven patients with nonunion of the scaphoid were treated by a limited approach combining a palmar wedge graft with insertion of a dorsal (retrograde) Herbert screw through small incisions. All patients had palmar bone deficiency and a ‘difficult’ proximal fragment. They were followed up for a minimum of 12 months (12 to 38). Radiological union was achieved in all. In five patients correction of instability of the dorsal intercalary segment which was present before operation, was achieved. On a wrist-scoring chart, all patients had an excellent or good rating. The limited combined approach allows correction of the deformity with rigid fixation and has the advantage of preserving most of the palmar ligaments

Various classifications of scaphoid fractures have been based on plain radiography, but there are difficulties in defining the actual fracture line without an appreciation of the three-dimensional anatomy. Radiological fracture lines were therefore mapped on transparent methylmethacrylate models of the bone. An analysis of 91 acute fractures showed that 11 were apparently incomplete. The other 80 showed three basic anatomical patterns: transverse through the waist, oblique in the plane of the dorsal sulcus, or of the proximal pole. There was some variation and comminution in these patterns, but no distal fractures of the body were seen. The interpretation of different radiological projections is discussed. The findings have implications for the management and the assessment of outcome