Unstable scaphoid nonunion treatment technique: use of a volar distal radius corticocancellous autograft

Scaphoid nonunions are challenging cases that first must be identified and then treated based on stability, collapse, and vascularity. Unstable nonunions are identified on the basis of collapse of the scaphoid into the "humpback" deformity with an increased intrascaphoid and scapholunate angles. The importance of restoring normal scaphoid alignment has been stressed, because failure to do so leads to worse clinical and radiographic results with predictable patterns of radiocarpal arthrosis. We present a technique to correct unstable scaphoid nonunions using a single volar-based incision with harvesting of volar distal radius corticocancellous autograft. This technique allows the avoidance of harvest site morbidity and has union rates comparable with the gold standard of iliac crest.