The Role of Vascularized Bone Grafting in Scaphoid Nonunion.

Management of scaphoid nonunions requires thoughtful preoperative and intraoperative consideration to evaluate for scaphoid flexion or humpback deformity, carpal collapse, and proximal pole vascularity. Most scaphoid nonunions do not require vascularized bone grafts; however, in the setting of avascular necrosis of the proximal pole, vascularized bone grafts should be used to optimize union rates. In addition, scaphoid geometry and carpal stability must be restored to enhance functional outcomes.