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J Wrist Surg 2017; 06(02): 158-162
DOI: 10.1055/s-0036-1585583
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tibial Bone Grafting for Wrist Reconstruction

Schneider K. Rancy
1   Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Stephanie D. Malliaris
1   Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
,
Scott W. Wolfe
1   Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

29 September 2015

06 June 2016

Publication Date:
21 July 2016 (online)

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Abstract

Background Iliac crest bone graft harvesting is routinely performed for upper extremity orthopedic procedures despite high complication rates associated with sensory nerve injury, hematoma, chronic pain, and fracture.

Description of Technique Cancellous bone graft is harvested from the proximal tibia using a medial approach, minimizing donor site morbidity.

Patients and Methods A retrospective review was undertaken of 14 patients who underwent cancellous proximal tibia bone graft harvesting to augment healing of wrist reconstruction, with 2 months minimum follow-up. We report donor limb tourniquet time, time to union, visual analog scale (VAS) pain score, and complications. Patients were also contacted by phone to administer a retrospective questionnaire and record experiences with the harvesting technique.

Results Average donor site VAS for the immediate postoperative period was 7.4. Average tourniquet time was 28 minutes. Average time to union of the recipient site was 45 days. One patient experienced delayed union after corrective osteotomy, attributed to osteoporosis. Two patients underwent hardware removal from the operative wrist, unrelated to bone graft harvesting. One patient with a history of chronic neuropathy and foot drop developed dysesthesia and allodynia about the ipsilateral ankle, but was asymptomatic at the proximal tibia donor site; ankle symptoms resolved 3 weeks postoperatively. No patient reported any residual donor site difficulties 24.2 months postoperatively.

Conclusion In consideration of the minimal complication rate, favorable clinical parameters, and excellent patient tolerance, we advocate proximal tibia bone graft harvesting as opposed to iliac crest harvesting for wrist reconstruction when a moderate amount of autogenous cancellous graft is needed.

Level of Evidence IV.

Keywords

bone graft - proximal tibia - complications - distal radius malunion - pancarpal arthritis
 

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