Minimally invasive management of scaphoid nonunions

Not all proximal pole scaphoid nonunions with avascular necrosis require vascularized bone graft or a formal open incision. If the distal scaphoid is well perfused and the proximal pole can be secured rigidly after percutaneous bone grafting, then nonunion repair and healing can proceed. We describe minimally invasive techniques that permit fracture site debridement, establishment of distal perfusion by central axis reaming, arthroscopic assessment of perfusion, percutaneous bone grafting, and rigid internal fixation. As surgeons develop new minimally invasive techniques, it is still imperative to continue to base treatment on scaphoid nonunion pathology and the key principles in the treatment of any nonunion.