The Herbert screw's unique double-threaded design allows for complete subchondral containment and offers the theoretical advantages of earlier return to function and elimination of the need for removal (in contrast to other internal fixation devices) for the management of scaphoid fractures and nonunions. Its use is technically demanding and associated with a significant learning curve. Indications and contraindications for use of the Herbert screw in scaphoid fractures and nonunions are discussed, as are the specific technical details to which the surgeon must adhere for successful application of the device. Common pitfalls associated with use of the Herbert screw and ways to avoid them are also described.