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Bone Graft Harvesting in the Upper Extremity: A Comparison of Two Techniques
Alan J. Micev, MD1; William Slikker, MD2; Ross Richer1; Mark Cohen2; David Kalainov1
1Northwestern University, Chicago, IL; 2Rush University, Chicago, IL

Introduction: Harvesting autogenous bone graft from the distal radius or olecranon process poses several advantages in upper extremity surgery, however, many are reluctant to consider the olecranon process as a graft source. This study compares distal radius and olecranon bone graft harvesting.
Methods: Forty patients who underwent bone graft harvesting from the distal radius (DR, 15) or olecranon process (OP, 25) were evaluated retrospectively. Graft was obtained from the ipsilateral extremity using comparable techniques, and was positioned at least one bone or joint away from the recipient site. The average follow-up was 15 months. Outcome measures included Visual Analog Scales (VAS) of pain at the graft site and satisfaction with the appearance of the scar; physical examination; and radiographs of the harvest and recipient regions. The VAS scores ranged from 0 to 10 with 0 indicating no pain and excellent satisfaction, and 10 indicating severe pain and poor satisfaction. The VAS scores were compared between the 2 graft harvest site groups. Joint motion and grip strength measurements were compared between operative and nonoperative limbs in each patient.
Results: The VAS scores for pain averaged 0.33 (range, 0 - 3) in the DR group and 0.40 (range, 0 - 4) in the OP group. Residual pain at rest was reported in 20% of patients in both groups. The mean VAS scores for satisfaction with cosmesis averaged 0.67 (range, 0 - 4) in the DR group and 0.28 (range, 0 - 2) in the OP group. There were no significant differences between groups for the VAS scores. Joint motion measurements were equivalent between the graft harvest site and the corresponding joint in the contralateral extremity in all patients. There were no significant differences in grip strength measurements between limbs in the DR patients, whereas grip strength measurements in the nonoperative limb were significantly greater in the OP patients (mean 74 + 27 pounds vs. 61 + 24 pounds). Recipient site bone healing was observed radiographically in 86% of patients in both groups. A radiographic defect was identified in 71% of the DR cases and 84% of the OP cases. Complications occurred in 25% of DR cases and 20% of OP cases, but no patients required additional surgery.
Conclusions: Autogenous bone graft harvesting from either the distal radius or olecranon process led to comparable patient outcomes. Complications occurred at similar rates in both groups, but all resolved without the need for additional surgery.


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