Scaphoid nonunion is challenging to manage because of the geometry of the scaphoid, the direction and type of fracture, and the vascular pattern of the blood supply to the scaphoid. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Delayed diagnosis, inadequate initial management, proximal fracture location, osteonecrosis, and associated carpal instability with acute scaphoid fracture can lead to nonunion of the scaphoid waist or the proximal pole.1 Nonunion can exist with or without osteonecrosis of the proximal fragment. Osteonecrosis of the proximal pole can occur with a scaphoid waist nonunion, but there is almost always loss of blood supply in proximal pole scaphoid nonunion. Nonunion involving the scaphoid waist often has significant bone loss and carpal collapse, along with volar rotation of the distal pole, which produces an apex dorsal humpback deformity.