A technical modification to avoid accidental graft drop during hemihamate osteochondral graft harvesting

During graft harvesting for hemihamate arthroplasty, one potential intraoperative complication is accidental graft drop. In this technique, we present a technical modification designed to prevent inadvertent graft drop during the harvesting process. During hemihamate graft harvesting, after adequate exposure of hamate, dorsal cuts are made with a saw blade. Based on preference, a K-wire is placed dorsally into either the radial or ulnar half of the graft, taking into consideration its use as a guide for future screw placement. The wire is held by an assistant. The K-wire diameter is selected to correspond with the intended screw; in the authors' technique, a 1.0 mm K-wire is used as a guide when 1.2 mm screws are planned. The wire is advanced to an appropriate depth, ensuring it will not interfere with subsequent cuts made by saw or osteotome. The initial cut is made using a saw blade, and graft removal is completed with an osteotome. The pre-positioned K-wire prevents the graft from inadvertently falling. Once retrieved, the graft is shaped as needed, and drilling is completed through the K-wire entry point before definitive fixation is achieved using screws.