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Internal fixation of the scaphoid using a plate has been reported in the literature as far back as 1977. Recently, a specific plate designed for scaphoids has been developed, which provides considerably more buttress support than intramedullary headless screws, and offers a reliable method of rigid internal fixation for complex fractures. Indications to use such a plate include complex acute fractures, such as those with significant waist comminution or steep reverse oblique fractures, and complex nonunions with central bone loss resulting from failed previous headless screw fixation. This is now the authors' preferred treatment for these injuries.

The minimally invasive nature of wrist and small joint arthroscopy renders it particularly suitable for the application of the wide-awake local anesthesia no tourniquet (WALANT) technique. The application of WALANT wrist and small joint arthroscopy has given surgeons the ability to visualize both static and dynamic movements of a joint, to show the pathology and discuss with the patient, and to visualize a patient's repaired structures. This reinforces confidence in surgeons and encourages patients to comply with postoperative rehabilitation.

In the patient in whom primary distal radioulnar joint surgery has failed, consideration must be given to the anatomy and biomechanics of the native joint; how this has been disrupted by injury, disease, and previous trauma; and what is required to reconstruct the joint. The forearm relies on a congruent condylar cam of the distal ulna, with intact soft tissue restraints for normal biomechanics. Surgical reconstruction using tendon graft, autologous bone graft, allograft interposition, and prosthetic reconstruction are discussed in this article. If these procedures fail, then salvage procedures including wide excision of the ulna or one-bone forearm can be performed.