60 consecutive patients with fractures of the waist of the scaphoid were randomized to management with percutaneous fixation with a cannulated Acutrak screw or cast immobilisation. At 1 year, the scaphoid fractures fixed with percutaneous screw fixation reported a quicker time to union than those treated with a cast. A non-statistically significant trend was noticed towards a higher nonunion rates in the non-operative group. Patients treated operatively regained function and returned to sport and full work quickly compared with those managed conservatively.