George Dyer, MD, is an Orthopaedic Surgeon at Brigham and Women’s Hospital, and Instructor of Orthopaedic Surgery at Harvard Medical School. Here, Dr Dyer shares a useful trick for simplifying the delivery of allograft bone chips to a small graft site.
The conventional method of delivering bone chips into an area to be grafted typically involves plucking them out of a little bowl with forceps and trying to place them into the recipient site without spilling them everywhere. This often results 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 rectangular 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. The hole can be sized to the aperture of the graft recipient site. 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.
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.
The port can be sized to fit exactly over the graft site.
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.
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 something else that cannot be modified into a funnel, a disposable plastic rectangular basin can be used instead.
Post-op radiograph of patient with supracondylar humerus fracture (see opening radiograph), s/p ORIF with allograft placed using the above technique.