Percutaneous cannulated screw fixation (PCSF) of acute scaphoid fractures has been shown to consistently produce good results. It is less invasive and avoids damage to the radiocarpal ligaments. The scar is good. The procedure could be performed under Bier's block anaesthesia. No cast is required after the operation and the range of wrist motion is regained early. Most recently reported series achieved more than 95% primary radiological fracture union. The functional results were good. The surgical technique of PCSF is described in detail and special tricks for difficult problems are highlighted.