Pathologic fracture of the proximal ulna through a bone graft donor site

Complications of harvesting autologous bone graft from the iliac crest and tibia are well known; exclusive use of upper extremity donor sites in hand surgery has therefore been advocated. Six weeks of postoperative elbow splinting has been recommended after harvest of large proximal ulnar grafts. We report two cases of pathologic fracture of the proximal ulna complicating local bone grafting and question whether the risk of fracture and the attendant patient inconvenience and potential joint stiffness incurred by postoperative immobilization are exceeded by the morbidity of carefully done iliac crest grafting.