Authors: Judith F Baumhauer
Publish Date: 2016/06/02
Volume: 474, Issue: 9, Pages: 1933-1938
Abstract
We are pleased to present the next installment of “Pearls” a column in Clinical Orthopaedics and Related Research® In this column distinguished surgeons scientists or scholars share surgical or professional tips they use to help surmount important or interesting problems We welcome reader feedback on all of our columns and articles please send your comments to eicclinorthoporgThe author certifies that she or any member of her immediate family have no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted articleThere are many orthopaedic surgical procedures that call for the placement of bone blocks in order to gain length and/or alter alignment 1 2 4 Two such operations include lateral column lengthening for correction of a flatfoot deformity and placement of a segmental bone graft to salvage bone loss due to Charcot arthropathy or a failed joint replacement of the ankle or halluxRegardless of the surgery placing these bone blocks with good interference fit and without fragmentation can be difficult The goal is to have excellent bonetobone contact between the bone block graft and the host bone to allow for union I use a simple technique that successfully places the segmental bone block without damage to the adjacent host surfaces or the bone graft and utilizes readily available instrumentationTwo osteotomes sized the same as the adjacent host bone surfaces are positioned against these surfaces the bone block graft is placed between these osteotomes and manually pressed into place as far as possible using the osteotomes as if they were functioning as a skid The smooth surface of the osteotome allows the autograft or allograft to slide along the surface with less friction than the cancellous rough bone At a point when the graft will not advance any further the osteotomes ends are “pinched” together using the graft as a fulcrum to allow the osteotomes to open the deeper area and allow the graft to be advanced further and seated A bone tamp and mallet can be used carefully as less force is needed to advance the graft and therefore there is less chance of damage to the bone block Once the bone block is seated the osteotomes can be removed carefully while manually holding the bone graft to keep it in place Fixation to stabilize the graft is performed using the individual surgeon’s preference
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