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A simple technique to introduce bone chips to the surgical site.
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Trauma Rounds Case Reports from the Mass General Hospital and Brigham &Women’s Hospital A Quarterly Case Study Volume 1, Winter 2010
George Dyer, MD
This is a useful trick for simplifying the deliv-ery of allograft bone chips into a small space.
The conventional method of delivering bone chips into an area to be grafted typically in-volves plucking them out of a little bowl with forceps and trying to place them into the re-
cipient site without spilling them everywhere. This often re-sults in a mess: graft falls out of the forceps while en route to the surgical site, landing in soft tissues, on the drapes, or on the floor. Graft and time are wasted. This process is especially awkward when the recipient site is a small hole or window and the surgeon is attempting to pack the graft into it.
Several brands of allograft bone chips are supplied in a rectan-gular plastic tub. A simple solution to the delivery problem is to turn the allograft tub into a funnel by cutting one bottom corner off of it with a pair of heavy scissors (right top). The hole can be sized to the aperture of the graft recipient site (right below). This improvised funnel can be placed right against the recipient site, and a small tamp can be used to poke the graft out the hole through the bottom of the tub, and directly into the spot the surgeon wants (next page).
If anything is to be mixed with the allograft chips, such as autologous graft, blood, BMP or other substances or if the graft needs to be crushed to fit into the defect, it is best to do this first and then to cut the hole just before applying the graft. For autograft, or if the allograft is supplied in a glass jar or some-thing else that cannot be modified into a funnel, a disposable plastic rectangular basin can be used instead.
Trauma Rounds, Volume 1, Winter 2010 1
P A R T N E R S O R T H O P A E D I C
Delivering Allograft Bone Chips
Above: Cut off one of the bottom corners of the graft tub with heavy scissors. This can be done with the chips still in the tub.Below: The port can be sized to fit exactly over the graft site.
BREAKING NEWS: As this issue goes to press, our colleagues, Dr. George Dyer and Dr. Malcolm Smith have gone to Haiti as part
of Partners Humanitarian relief efforts. Read more at:
http://AchesAndJoints.org/trauma
Trauma FacultyMark Vrahas, MD — 617-726-2943Partners Chief of Orthopaedic [email protected]
Mitchel B Harris, MD — 617-732-5385Chief, BWH Orthopedic [email protected]
R Malcolm Smith, MD, FRCS — 617-726-2794Chief, MGH Orthopaedic [email protected]
David Lhowe, MD — 617-724-2800MGH Orthopaedic [email protected]
David Ring, MD — 617-724-3953MGH Hand & Upper Extremity [email protected]
George Dyer, MD — 617-732-6607BWH Hand & Upper Extremity [email protected]
Please send correspondence to:Mark Vrahas, MD / Trauma RoundsYawkey Center for Outpatient Care, Suite 3C55 Fruit Street, Boston, MA 02114
Editor in Chief Mark Vrahas, MD
Program DirectorSuzanne Morrison, MPH(617) [email protected]
Editor, PublisherArun Shanbhag, PhD, MBA
P A R T N E R S O R T H O P A E D I C T R A U M A R O U N D S
2 Trauma Rounds, Volume 1, Winter 2010
Above: Use a small elevator or bone tamp to push graft through the hole into the recipient site. The tub acts as a funnel to direct the graft exactly where you want it to go.
Trauma Fellowship Program wins funding from OMeGA Medical Grants AssociationWe are pleased and proud to report that our Brigham and Women’s Trauma Fellowship program was selected as one of the inaugural recipients of OMeGA Medical Grants Association’s fellowship grants. Our program was one of forty-four (44) selected nationally through a competitive process.
The OMeGA Medical Grants Association was established through the efforts of the world’s longest standing orthopaedic professional organization, the American Orthopaedic Association (AOA). OMeGA is an inde-pendent legal entity whose singular mission is to award and manage grants for orthopaedic graduate medical education through an open, accessible process designed to safeguard against potential conflicts of interest and to ensure transparency in the allocation of resources.
We are grateful to OMeGA for their support and generosity.
Left: Pre-op radiograph of a patient with a supracondylar humerus fracture.Right: Post-op radiograph of same patient s/p ORIF with allograft placed using the above technique.
