Proximal ulna corticocancellous autograft for the repair of metacarpal defect following ballistic hand injury

Metacarpal defects following ballistic hand injuries are a devastating complication that can compromise hand function. Autologous bone grafting is the gold standard treatment of these osseous defects, most commonly utilizing the anterior iliac crest as the donor site. Alternatively, use of corticocancellous bone graft from the proximal ulna has been described, although with mixed clinical outcomes. Additionally, the upper limit of defect that can be repaired with this technique remains unknown. Herein we described the case a patient who sustained a partial extensor tendon injury and significant fourth metacarpal defect following ballistic injury who was subsequently treated with open reduction and internal fixation of the fourth metacarpal using a 2.5 cm corticocancellous bone graft harvested from the ipsilateral proximal ulna, in conjunction with primary extensor tendon repair. The patient achieved successful radiographic union of the corticocancellous graft and appropriate filling of the donor site with restoration of digit flexion and extension.