An Easy Way of Harvesting Olecranon Bone Graft in Adults by Using Bone Biopsy Trephine

Abstract

The olecranon is a useful donor site for bone grafts in upper extremity surgery because of its minimal donor site morbidity, proximity to the recipient site, ease of adjusting volume and shape, and adequacy of the cancellous bone.1Mauffrey C. Madsen M. Bowles R.J. et al.Bone graft harvest site options in orthopaedic trauma: a prospective in vivo quantification study.Injury. 2012; 43: 323-326Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar, 2Mersa B. Ozcelik I.B. Kabakas F. et al.Olecranon bone graft: revisited.Tech Hand Surg. 2010; 14: 196-199PubMed Google Scholar For this purpose, we used a T-shaped bone biopsy trephine to harvest corticocancellous or cancellous bone graft from the olecranon successfully in 16 patients with complicated hand and wrist fractures (Fig. 1). Mean patient age was 27 years (range, 22–36 y). We make a small skin incision over olecranon and then incise and elevate the periosteum. We insert the trephine along the axis of ulna and rotate it to obtain the desired graft length. The trephine is then extracted by rotating in the same direction. The graft is gently pushed wire out of the trephine with a Kirschner wire. Mean operation time from skin incision to closure was 5 minutes (range, 3–7 min). No postoperative elbow immobilization was needed. Patients started resting on the elbow after 10 days. There were no pathologic fractures, contour deformities, or sensory or motor deficits. Fujita et al3Fujita K. Yuzuriha S. Matsuo K. Usefulness of skin trephine in minimally invasive cancellous bone harvesting for secondary alveolar bone grafting in young patients.Plast Reconstr Surg. 2010; 126: 85e-86eCrossref PubMed Scopus (2) Google Scholar used a skin trephine to harvest iliac crest bone in children, but this fragile trephine would not likely work in compact adult bone. Burstein et al4Burstein F.D. Simms C. Cohen S.R. Work F. Paschal M. Iliac crest bone harvesting techniques: a comparison.Plast Reconstr Surg. 2000; 105: 34-39Crossref PubMed Scopus (80) Google Scholar also compared the use of special bone trephines with the other graft-harvesting techniques in children. They noted that the trephine technique had less morbidity than conventional harvesting techniques while providing adequate bone for alveolar bone grafting. We decreased operation time, postoperative pain, and scar length without disturbing elbow movement or sensation. Our patients were young and had good bone stock. Bone density could be assessed in older patients to help assess the risk for pathologic fractures.