Nonvascularized structural corticocancellous bone grafting performed with bone from the olecranon showed some advantages over bone from the iliac crest for the treatment of large segmental bone defects of the phalanges, according to findings from a recently published case report.
Maximillian Soong, MD, reported on a patient with a large degloving wound in association with a comminuted fracture of the left thumb proximal phalanx that resulted in loss of segmental bone. Song treated the fracture initially with provisional pin fixation and repaired the extensor pollicis longus and the radial and dorsal digital nerves. After 3 weeks, nonvascularized corticocancellous bone graft from the olecranon was performed under regional anesthesia on the patient’s proximal phalanx, and the thumb was immobilized for 11 weeks.
Soong harvested the 10 mm x 15 mm corticocancellous graft from the olecranon via a posterior longitudinal incision, sagittal saw and curved osteotomes. The graft was placed over longitudinal K-wires and the periosteal tissues were subsequently sutured over the cortical bone, thus burying the longitudinal K-wire. At 5 weeks, a transverse K-wire initially used to secure the thumb bone fragments was removed, and at 11 weeks the longitudinal K-wire was removed.
Soong reported bony bridging of the graft on CT scan at 15 weeks. The patient ultimately regained moderate active extension and flexion of the thumb joints.
“This case shows that robust structural bone graft for the phalanges may be obtained from the nearby olecranon, under regional anesthesia, without microsurgery, and with potential advantages over the iliac crest,” Soong wrote in the study. – by Susan M. Rapp
Disclosure: Soong reports no relevant financial disclosures.