Corticocancellous olecranon autograft for metacarpal defect reconstruction: a case report

Abstract

Background: High-energy injuries to the hand frequently lead to bone defects as well as soft tissue loss. Early bone grafting of defects is well established in the literature; however, few options are available for autologous corticocancellous grafts. Most frequently cited studies describe the iliac crest or the distal radius donor sites.

Methods: In this case report, we describe a new technique of obtaining corticocancellous bone graft from the olecranon.

Results: Complete union of the segmental defect was achieved with this technique.

Conclusions: The olecranon donor site is outside the zone of injury and therefore safe to access, but within the upper extremity, thus avoiding the need for harvest from a distant site such as the iliac crest or the distal femur. Additional benefits of this site are the greater volume of graft that can be harvested compared to the distal radius as well as a more optimal ratio of cancellous to cortical graft available, compared to the iliac crest where the graft may be excessively cortical in nature.

Keywords: Autograft; Bone defect; Metacarpal; Olecranon.

Fig. 1

Injury radiograph

Fig. 2

Intraoperative fluoroscopic image after debridement with k-wire spanning fifth metacarpal defect

Fig. 3

Intraoperative image with fifth metacarpal defect filled with olecranon graft (a), followed by plate application (b)

Fig. 4

Xray (a) and CAT scan (b) at 3 months

Fig. 5

a Radiograph of ipsilateral elbow immediately after graft harvest. b Final radiograph of the donor elbow with evidence of healing in the defect