Scaphoid

ORIF & corrective inlay graft

Fernandez

• Pre op planning of correction required
• Approach volar side
• Cut wedge of non union out, drill 1mm holes into proximal pole if avascular
• Open volar surface with laminar spreader & simultaneously reduce DISI by pushing on volar corner of lunate
• Cut unicortical graft triangular of trapezoidal depending on lengthening required
• Place graft, K wires or Herberts screw

Tomiano

• uses tricortical grafts
• Reduces DISI by flexing wrist, pin lunate to radius, then supinate & extend wrist to address scaphoid

Stark

• Cuts trough like Matti-Russe but opens volar surface to accept longer graft