The classic volar Henry approach was extended distally toward the distal scaphoid tubercle and the capsule was opened (Fig. 15.2). The two ends of scaphoid were cleaned and any fibrosis excised. The scaphoid showed a humpback deformity. Reduction was performed with an osteotome and fixed with temporary K-wires.

The graft was harvested from the distal and ulnar aspects of the volar radius. The volar carpal artery is always located in the volar periosteum of the radius, just distal to the distal part of the superficial aponeurosis of the pronator quadratus. The superficial ­aponeurosis was opened over its last distal centimeter; the muscle was retracted and then temporarily fixed with a K-wire. The periosteum was sectioned longitudinally on the distal edge of the radius where the superficial aponeurosis of the pronator quadratus ends on the radius. The pedicle was elevated with the periosteum on the radial side (Fig. 15.3). The structural bone graft was harvested from the radius with an osteotome and shaped as a pyramid to fit perfectly in the scaphoid defect and to avoid any detachment of the periosteum and pedicle from the graft (Fig. 15.4). The pedicle was dissected up to the radial artery, where the volar carpal artery originates (Fig. 15.5).