A simple drape-based enclosure technique to reduce accidental hemi-hamate graft drop

Accidental graft drop during hemi-hamate arthroplasty is an uncommon but challenging intraoperative event, particularly because the harvested osteoarticular graft cannot be readily replaced. During our early experience with hemi-hamate arthroplasty, four accidently dropped grafts were decontaminated and reimplanted; none developed infection, and graft incorporation and union progressed as expected. However, the absence of complications in these limited cases does not eliminate the potential risks associated with graft contamination and subsequent decontamination. These events prompted us to develop a simple drape-based enclosure technique designed to reduce the risk of graft drop during harvest, preparation, and fixation. Our center has routinely performed hemi-hamate arthroplasty since approximately 2010. For the past 5 years, the drape-based enclosure technique has been routinely used by three hand surgeons in several hundred hemi-hamate arthroplasties, with no graft-drop event encountered while using this setup. Although this uncontrolled clinical experience does not establish the effectiveness of the technique, the described modification is simple, inexpensive, requires no specialized equipment, and may represent a useful adjunct during hemi-hamate arthroplasty.