Surgery was performed on an outpatient basis under general anesthesia in addition to an infraclavicular regional block for postoperative pain control. The patient was placed in the supine position with a bump under the ipsilateral hip to facilitate ICBG harvesting. A volar approach is preferred when correction of a humpback deformity is required. In this case, the patient’s previous volar incision was used to access the scaphoid and the radial styloid (Fig. 10.3). A ­radial styloidectomy was performed and previous hardware was removed. The scaphoid fracture was identified and the ­presence of a nonunion was confirmed. The ­proximal and distal poles were excavated and all nonviable bone was ­removed. Bleeding was noted at the proximal pole and therefore, a vascularized bone graft was deemed unnecessary. Scaphoid length and alignment were obtained using a small lamina spreader and Kirschner wires (K-wires) as joysticks. A guidewire was then placed in the center–center position in a retrograde fashion for later placement of a headless compression screw (Fig. 10.4). Wire position was confirmed by intraoperative fluoroscopy and by visualizing the pin as it traversed the nonunion site. The appropriate screw size was then determined. A tricortical autograft wedge graft was then harvested from the ipsilateral iliac crest and contoured on the back table to the proper size. An ­oscillating saw was then used to create a sagittal slit in the graft to allow placement of the graft over the central ­scaphoid ­K-wire (Fig. 10.5). The graft was then inserted into the defect and a derotational K-wire was placed. A compression screw was then inserted over the central guidewire and good compression was observed across the graft (Fig. 10.6, 10.7 and 10.8). The patient was immobilized in a sugar tong splint to prevent forearm rotation.