Treatment of scaphoid non-unions is still challenging for responsible hand surgeons, especially in cases of avascular proximal pole non-unions or failed prior surgeries. Several surgical procedures treating scaphoid non-unions have been established. These aim to restore correct anatomy to provide stability and adequate blood flow. Treatment options range from avascular to free, vascularized bone grafts. The two most used free vascularized bone grafts derive from the iliac crest and the medial femoral condyle. The vascular anatomy of the medial femoral condyle graft is more constant, the donor site morbidity lower and the healing rate higher in comparison to the iliac crest graft. It is easier to harvest the femoral condyle graft and additionally, it can be harvested as a cortico-cancellous or osteochondral graft. Looking at all advantage, we come to the conclusion that the free vascularized medial femoral condyle graft is our method of choice for the treatment of a avascular proximal pole non-union of the scaphoid.© Georg Thieme Verlag KG Stuttgart · New York.