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The Herbert screw for fractures of the scaphoid.

In 1954, Harrison McLaughlin of the Columbia-Presbyterian Hospital in New York City published a paper in the American volume of this journal in which he described the use of a screw to fix fractures of the scaphoid. He had used vitallium lag screws in 19 patients over nine years, and distinguished between stable fractures, which were easy to fix, and unstable ones which were difficult and needed preliminary stabilisation with a Kirschner wire. In 1969, he and Parkes classified scaphoid fractures into three groups based on their operative findings. These were an unstable group and two types of stable fracture: in the first there was an intact cartilaginous shell around the fractured bone, the "peanut" fracture. In the second the articular cartilage was also broken, but not through its entire circumference; these could sometimes "open and close like a book when the wrist was moved." These ideas were taken up enthusiastically by a young English orthopaedic registrar, Mr T. J. Herbert, who, in 1974, read a paper to the Orthopaedic Section of the Royal Society of Medicine differentiating between stable and unstable fractures of the scaphoid and advocating internal fixation of the unstable ones. As a result he was asked to do these operations. Finding them difficult, he set about designing a jig in the laboratory at the Rowley Bristow Orthopaedic Hospital where he was Senior Registrar to Mr Alan Apley. A jig which could accommodate the rather bulky screws then available was too large for the scaphoid, and he therefore decided to make a smaller screw. While thinking about it, he hit upon the original idea of a screw with two threaded sections of different pitches which would automatically provide some compression. The screw had no head so that its trailing end could be buried beneath the surface of the scaphotrapezial joint. The final version of his jig was similar to one designed by an American surgeon called Huene. In 1975, Tim Herbert became Senior Lecturer to Professor Ron Huckstep at the University of New South Wales, and continued to work on his double-threaded screw. Its manufacture presented difficulties, but he collaborated with a young engineer called Fisher who made the first 100 Herbert screws in his garage from Steinmann pins. After 18 months of experimental work, the first screws were implanted in 1977. A multicentre clinical trial in Australia led to further refinement and the screws became commercially …