A, Lunate extension (dorsal intercalated segment instability deformity) accompanies scaphoid nonunion with humpback deformity because of carpal collapse. B, With wrist extension, radiolunate joint is pinned and scaphoid opens at nonunion site. Microsagittal saw is used to smooth ends of bone at nonunion. C, Tricortical iliac crest graft is harvested. D, Graft is pinned in place before insertion of Herbert-Whipple screw. Lunate transfixion pin is removed before screw placement to facilitate accurate imaging of scaphoid and guidewire. (Redrawn from Tomaino MM, King J, Pizillo M: Correction of lunate malalignment when bone grafting scaphoid nonunion with humpback deformity: rationale and results of a technique revisited, J Hand Surg 25A:322, 2000.) SEE TECHNIQUE 69.14.