Immediate corticocancellous bone autografting in segmental bone defects of the hand

We performed a retrospective analysis of 12 type III open hand fractures in seven patients with segmental bone loss and associated soft tissue injuries to determine the effectiveness of immediate autologous corticocancellous bone grafting. Radical débridement and fracture fixation were performed prior to bone grafting. Results were interpreted according to clinical and radiologic time of bony healing, rate of infection, time to return to regular work duty, grip strength, rate of complications and range of motion. The final union rate was 92%, with a mean time to bony union of 18 weeks. The infection rate was 0%. The mean time to return to regular work duty, including recovery time after secondary surgeries, was 5 months and 21 days. All patients returned to their pre-injury employment. The mean total active motion of the combined metacarpophalangeal proximal interphalangeal and distal interphalangeal joints in bone-grafted digits was 178 +/- 53 degrees at final follow-up.