Olecranon Bone Graft Research Articles

High Rate of Union of Scaphoid Pseudoarthrosis Treated With Arthroscopic Olecranon Bone Graft Using Antegrade Percutaneous Headless Compression Screw

To assess the healing rate of scaphoid pseudoarthrosis treated with wrist arthroscopy, olecranon bone graft, and anterograde screw fixation, as well as evaluate complications and clinical and radiologic outcomes. All patients with scaphoid nonunion were selected between January 2017 and December 2022. Inclusion criteria were patients between 18 and 60 years of age, a diagnosis of scaphoid pseudoarthrosis, complete clinical patient-reported outcomes, radiographic measurements, and at least a 1-year follow-up. Scaphoid pseudoarthrosis was treated arthroscopically with olecranon bone graft and anterograde screw fixation. Clinical assessment was performed through visual analog scale (VAS) for pain, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, wrist range of motion using a standard goniometer, and grip strength in kilograms with a Jamar hydraulic hand dynamometer. Clinical relevance was measured with the minimal clinically important difference (MCID) for VAS and QuickDASH. Scapholunate angle was measured. Union was assessed on a computed tomography scan. Seventeen patients were included with a mean follow-up of 17.2 months. The mean age was 30.1 years, and the average time from injury to arthroscopic surgery was 11.1 months. At latest follow-up, there was an improvement in VAS pain score and QuickDASH score. Range of motion and grip strength increased at last follow-up. MCID threshold for the VAS and QuickDASH score was reached by 100% and 94.1%, respectively. Union was achieved in 16 patients (94.1%) after a median of 16 weeks (interquartile range, 16-20). Arthroscopic treatment of scaphoid pseudoarthrosis with olecranon bone graft and antegrade percutaneous headless compression screw allows a high grade of union and improves pain and function at short-term follow-up. Level IV, therapeutic case series.

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion. Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed. Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P= .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P= .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P= .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P= .014). Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion. Level IV, therapeutic case series.

Augmentation rhinoplasty using olecranon bone graft.

Background:Correction of saddle nose deformity is one of the most frequently sought surgeries by patients seeking rhinoplasty in Asian countries. Nasal dorsal augmentation always requires graft material to achieve the desired result. Various autologous grafts and alloplastic materials have been described in the literature with their advantages and disadvantages. We report our study on the use of olecranon bone graft for augmentation rhinoplasty in severe saddle nose deformity and discuss our experience with it.Materials and Methods:In this observational study, 12 patients who underwent dorsal nasal augmentation using olecranon bone graft from August 2011 to December 2020 were studied. All ten patients with congenital deformity underwent graft insertion through a closed rhinoplasty approach, whereas two patients with posttraumatic deformity were operated through old scars over the nasal dorsum. The graft was fixed with screws at nasion in both posttraumatic cases. All the patients were evaluated postoperatively at regular intervals for graft resorption by clinical photographs and X-ray nasal bone.Results:The age ranged from 20 years to 48 years. No immediate complications related to graft placement were noted. One patient had a hairline fracture of the ulna at the donor site on the 3rd postoperative day which was managed conservatively with a cast. The mean follow-up period was 2 years. No nasal dorsum projection loss or signs of bone resorption were observed for up to 5 years after surgery. One patient with posttraumatic deformity required removal of fixation screw which got exposed after 2 years of surgery.Conclusion:Olecranon bone graft is a suitable material for nasal dorsal augmentation in severe saddle nose deformity because of ease of harvest and minimal donor area morbidity. The appropriate thickness of the cortex of the olecranon process allows custom molding and provides resistance to resorption in long term, thereby giving a desirable outcome.

Olecranon bone grafting for the treatment of nonunion after distal finger replantation

Aim: Although not very popular, the olecranon bone graft is a useful option for this type of operation due to the minimal donor morbidity and its ease of use in small bone defect reconstruction and non-union therapy. To our best knowledge, few studies have evaluated the use of the olecranon bone graft as a treatment for non-union after distal finger replantation. Our aim in this report was to present our experience of using olecranon grafts in our nonunion patients undergoing distal replantations. Methods: Between 2013 and 2019, a total of 14 patients who developed nonunion or had segmental bone defects due to the injury were included in the study. Retrospectively the results were analyzed in terms of complication and union rates. Results: The mean follow-up period was 37 months (range 8-72 months). No major complications were seen in the donor region or recipient regions. One patient developed necrosis in the nail bed and one patient had a hematoma in the donor site. The minor complications were solved without any problem. Conclusion: In conclusion, we found the olecranon bone grafting for the treatment of nonunion after distal finger replantation is a safe and convenient method. It can be preferred as the first choice for nonunions of distal finger replantations.

The role of olecranon autograft as a void filler in the surgical management of enchondroma of the phalanx- A case report

Enchondromas of the phalanx are common benign tumours. They exhibit a monostotic or polyostotic pattern of presentation.These lesions are symptomatic and are usually diagnosed coincidentally. We report a 56-year-old female patient who presented to us with complaints of pain and swelling of the left-hand fourth finger when it was jammed in a gate. Plain radiograph of the hand confirmed the diagnosis of an enchondroma. A surgical curettage and olecranon bone graft was performed in this patient. In this article, the authors attempt to highlight the advantages of olecranon bone harvesting and the good functional results associated with this graft. Our patient had a good functional outcome with no evidence of recurrence at the end of one year.

Vascularized Olecranon Bone Graft: An Anatomical Study and Novel Technique

Autologous bone grafting is commonly used in reconstructive hand surgery. Various sources of nonvascularized autologous bone grafts have been described in the literature. However, in some situations, a vascularized bone graft may be needed. Popular vascularized bone grafts aretaken from the distal radius, iliac crest, and medial femoral condyle. The purpose of this study was to examine the feasibility of harvesting a free vascularized bone flap from the proximal ulna. Latex was injected via the brachial artery to facilitate visualization of perforators in 10 cadaveric specimens. Dissections were performed of the olecranon; all periosteal perforators were noted, and their lengths and diameters recorded. Corticocancellous bone flaps with their supplying pedicles were harvested. Three additional fresh specimens were injected with india ink via the pedicles to demonstrate perfusion of the harvested bone flap. Consistent vascular anatomy supplied the olecranon. A perforator from the posterior ulnar recurrent artery supplied the proximal ulna and olecranon, from which a vascularized bone flap can be harvested. Branches to the flexor carpi ulnaris muscle may allow chimeric flaps to be harvested. Average pedicle length was 5.8 cm and average pedicle diameter was 2.4 mm. India ink injection of the pedicles showed perfusion of the periosteum as well as intraosseous cancellous bone. A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent artery. Vascular anatomy is consistent and flap harvest is simple and straightforward in all cadaveric specimens. A vascularized olecranon free flap represents a potential new surgical option when vascular bone flap reconstruction is considered.

TREATMENT OF SCAPHOID NONUNION WITH OLECRANON BONE GRAFT AND COMPRESSION SCREW.

ABSTRACTObjective: To evaluate the outcome of olecranon bone graft and compression screw for the treatment of nonunion of the Lichtman type I scaphoid.Method: We evaluated 15 patients of 32 who underwent surgical treatment for nonunion of the Lichtman type I scaphoid with olecranon bone graft and screw compression.Results: We obtained 100% consolidation in our sample. The mean flexion of the wrist on the affected side was 68° and 75° on the non-affected side. The average extension was 63° and 72°, respectively. The average grip strength was 35 kgf. This corresponds to 98% of the handgrip strength of the non-affected side, which was 37 kgf. The DASH score averaged 5 points.Conclusion: We believe that the use of bone graft obtained from the olecranon and secured with cannulated screw is a resolute technique for cases of linear nonunion of the Lichtmann type I scaphoid. It has the advantages of a new anesthesia for removal of the graft and the access is easy, providing a good exposure for removal and good aesthetic results. Level of evidence IV. Case series.

Harvesting olecranon bone graft in adults by using bone biopsy trephine

Objectives: Bone grafts have been used for more than one hundred years in orthopedic surgery. Autografts are still the gold standard with respect to their osteoconductive, osteoinductive and osteogenetic peculiarities. Cancelleous grafts are the most commonly used autografts with their porous structure increasing the contact area. Although iliac crest is the preferred donor site, the femur, tibia, distal radius and olecranon are also employed when they are in a suitable location for the recipient site. The olecranon donor site can provide ample amounts of bone graft for reconstruction in the upper extremity. Here, the bone graft harvesting from the olecranon with the use of trephine as a safe and fast technique is presented. The bone graft harvested with trephine not only has the proper morphology to be used for phalanx and metacarpal reconstruction, but also can be utilized for wrist and forearm procedures. Methods: 82 patients (21 female) had bone reconstruction with olecranon bone graft harvested with trephine between 2010 and 2015. The mean age was 34 (range: 20-62) years. The mean follow-up period was 26 (range: 6-48) months. Results: None of the patients had pain or decrease in the range of motion in the early or late postoperative period. Only one patient (1.2%) had hematoma formation at the donor site and no other complications were observed in any patient. There was no difference in elbow extension strength between both elbows at the postoperative fifteenth day and at the end of the follow-up period. Conclusion: Bone graft harvesting with trephine is technically easy and fast, and donor site morbidity is diminished compared other methods and donor sites. It can be performed under axillary anesthesia and provides adequate amounts of bone graft for upper extremity reconstructions.

A New Option for the Reconstruction of Orbital Floor Defects

Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to its weak anatomic structure. Autogenous bone is a commonly used option for the reconstruction of orbital floor defects by many authors and institutions. This article introduces the olecranon bone graft as a new option for orbital floor reconstruction. The study is based on the analysis of 13 patients with orbital floor fracture operated on by using the olecranon bone graft. The mean age of the patients was 34 years 6 months. The physical examination of 5 (38.5%) patients revealed diplopia, 3 (23%) patients gaze restriction, 3 (23%) patients infraorbital nerve paresthesia, and 7 (53.8%) patients enophthalmos with various degrees. The mean defect size was 21.15 × 14.08 mm and the mean defect field was 2.98 cm2. All patients were operated on under general anesthesia and the orbital floor defect was exposed subperiosteally. The olecranon bone graft was harvested in 10 cases using a 3-cm incision over the olecranon and in 3 cases using the bone biopsy trephine and placed to the orbital floor defect after shaping with cottle cartilage crusher. Both clinical and radiological follow-up examinations were carried out in the postoperative period. The mean follow-up period of the patients was 7.92 months. The mean size of the grafts was 24.85 × 17.54 mL. The mean field of the grafts was 4.26 cm2. Among the 7 patients who had enophthalmos before the surgery, complete resolution was observed in 6 (85.7%) patients and in the remaining 1 (14.3%) patient, the degree of enophthalmos was found to be significantly reduced at the postoperative sixth month examination. All patients with preoperative diplopia and gaze restriction showed complete healing in the postoperative period. Eleven (84.6%) patients showed mild pain at the olecranon donor area with complete relief in the postoperative 3 days and the remaining 2 (15.4%) patients had moderate pain sensation which completely passed away at the postoperative fifth day. The olecranon bone graft is a suitable autogenous option for orbital floor reconstruction due to its considerable strength and molding capacity with low rates of complications and donor area morbidity.

Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study-80 Case Studies and 6 Years of Follow-Up.

Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.

Enxerto ósseo de olécrano para aumento do dorso nasal

BACKGROUND: Rhinoplasty surgery, performed for the treatment of saddle-back nose, has significantly improved in the last decades due to better management of grafts and implants. However, the choice of these materials is controversial and remains a subject of discussion. Scar contracture forces in nasal deformities prevent any type of reconstruction that is not rigid or semi-rigid. Therefore, the bone graft is an appropriate choice because it is stable, available, and reliable with regard to aesthetic outcomes. The olecranon bone graft is easily harvested and has a single cortical thickness, which is essential for resisting bone resorption and for providing long-lasting cosmetic results. The aim of this study is to discuss the advantages of the olecranon bone graft in rhinoplasty and to demonstrate our experience with this procedure. METHODS: In this descriptive and retrospective study, we reviewed the medical records of patients who underwent olecranon bone grafting for nasal dorsal augmentation between January 2000 and January 2010 and were consequently followed-up for an equivalent period, at the Plastic Surgery Service of Hospital Daher Lago Sul (Daher Lago Sul Hospital, Brasilia, DF, Brazil). Possible graft resorption was monitored by anthropometric measurements of the nose with photographic documentation and graft radiological control. RESULTS: Satisfactory aesthetic results were achieved for the 9 patients who underwent surgery. According to the examinations performed to monitor possible graft resorption, projection loss or signs of bone resorption were not observed for up to 6 years after surgery. CONCLUSIONS: The olecranon bone graft proved to be a suitable choice for primary or secondary rhinoplasty to treat saddle-back nose, with no long-term resorption or morbidity of the donor area observed up to this point. Moreover, the olecranon bone graft provides satisfactory, predictable, and long-lasting aesthetic results.

Technique of Olecranon Bone Grafting for Surgical Fixation of Scaphoid Fractures

Currently described sources of bone graft, such as iliac crest and distal radius, for supplemental fixation of scaphoid fractures are suboptimal. In our experience, olecranon bone has the advantage of providing a convenient source of corticocancellous block graft that can be harvested within the same sterile operative field used for fixation of the scaphoid fracture, and it also causes less postoperative pain compared to that obtained from iliac crest. Here, we describe our surgical technique for harvest and use of olecranon bone graft for fixation of scaphoid fractures.

Treatment of nonunions of the distal phalanx with olecranon bone graft

Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx. The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability) and radiological signs of nonunion more than 4 months after the initial injury. Three patients had developed infection and four of them had bone resorption after their initial treatments, which probably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation was done in all patients. The mean follow up was 7 months (range 5-18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one. There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.

The olecranon bone graft for nasal augmentation

The olecranon bone graft offers an alternative to the cranial bone when autogenous material is preferred in the repair of moderate deficiencies of the nasal dorsum. The predictably thick cortex of the olecranon allows the crafting of a customized implant, and minimal donor site morbidity makes it a safe alternative to the cranial graft.