Iliac Crest Bone Graft With Intramedullary Headless Implant for Metacarpal Bone Loss

Abstract

: Metacarpal bone loss presents a challenging reconstructive dilemma for hand surgeons. While multiple bone grafting techniques have been described, complications including nonunion, graft resorption, fixation requiring prolonged immobilization, stiffness, and the need for multiple procedures are well-documented. We present a technique for managing metacarpal bone loss utilizing a tri-cortical iliac crest graft and an intramedullary metacarpal nail for the treatment of metacarpal fractures and nonunions that is technically simple, fast, and allows for early initiation of motion to decrease postoperative complications. Level of Evidence: Level IV- Therapeutic

Clinical, Radiologic, and Functional Outcomes following Bone Grafting for Metacarpal Non-Unions: A Systematic Review

“…While guidelines advise using internal over external fixation in the treatment of metacarpal non-union, both approaches can be employed synergistically alongside bone grafts in accordance with a surgeon's preference [37,38]. Although internal fixation may result in extensor lag or stiffness, it allows for adequate alignment and bone stability [38]. On the other hand, fixation techniques like external fixation or K-wires require hardware removal and carry a risk of infection at the fixation sites [38].…”

“…Although internal fixation may result in extensor lag or stiffness, it allows for adequate alignment and bone stability [38]. On the other hand, fixation techniques like external fixation or K-wires require hardware removal and carry a risk of infection at the fixation sites [38]. In Aguilera et al's study, 50% of patients (n = 2) underwent non-vascularized bone grafting alongside ORIF, while the remaining half underwent internal fixation alone (n = 2) [39].…”

“…Defects characterized by inadequate vascular supply to the adjacent soft tissue, infected fractures, or secondary cases after unsuccessful reconstruction with non-vascularized grafts also require vascularized bone grafting [50][51][52]. Traditional non-vascularized bone grafts are not recommended in cases of poorly vascularized bone beds [38]. The current literature describes a bone gap greater than 6 cm to be an indicator for the use of a vascularized bone graft [50][51][52].…”