Background: Social costs are reduced by using percutaneous fixation rather than cast immobilization for acute non-displaced fractures of the scaphoid's mid-waist. Objective: The purpose of this study was to evaluate the clinical and radiographic outcomes of Herbert screw versus non-operative treatment for acute, non-displaced waist scaphoid fractures. Patients and methods: A randomized controlled clinical trial was conducted on 18 adult patients with acute non-displaced waist scaphoid fractures attended at the Emergency Unit, Orthopedic Surgery Department, Zagazig University. Nine patients were treated conservatively with a scaphoid cast (Group 1), and the remaining nine were treated surgically with a Herbert screw (Group 2). Results: The mean union duration was 9.8 (SD 4.8) weeks and 7.9 (SD 3.3) weeks among group 1 and 2 respectively. The median was 10 and ranging from 8 to 16 weeks among group 1 and was 8 and ranging from 8 to 12 weeks among group 2. About 11.1% had non-union wrist in groups 1 and 2. Union duration did not differ significantly between both groups. The pain score was 18.9 (SD 7.9) among the participants, and the satisfaction score was 18.6 (SD 8.4) among the participants. The mean range of motion was 20.3 (SD 6.3) among the participants, and the mean grip strength was 17.2 (SD 5.5) among the participants. The mean total score was 75.6 (SD 23.5) among the participants and there were 16.7% had poor results, 11.1% had fair results, 38.9% had good results and 33.3% had excellent results. Conclusion: Cast immobilization is the standard of care for treating acute non-displaced scaphoid waist fractures however percutaneous fixation with a Herbert screw has some advantages.