Scaphoid nonunion combined with avascular necrosis of the proximal pole remains a challenging problem in wrist reconstructive surgery. We report the case of a 40-year-old female who presented with right wrist pain, a restricted range of wrist motion, and grip weakness. Radiographic and computed tomography images showed scaphoid nonunion together with fragmentation of the proximal pole and a dorsal intercalated segment instability ( DISI ) deformity without any obvious osteoarthritic changes. Magnetic resonance imaging demonstrated low signal intensity in the proximal pole on both T1- and T2-weighted images, which was indicative of avascular necrosis. The proximal pole was unsalvageable ; therefore, excision of the proximal scaphoid fragment and reconstruction with a vascularized medial femoral trochlea ( MFT ) osteocartilaginous flap were performed. At 17 postoperative months, the patient’s pain had reduced, and her range of wrist motion and grip strength had improved. Radiographs confirmed that the reconstructed scaphoid bone had healed and the patient was free from DISI deformities. The vascularized MFT osteocartilaginous flap is a valuable surgical option for unsalvageable proximal pole scaphoid nonunion.