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

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.1,2
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 al3 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 al4
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.