Olecranon Bone Grafting in Upper-limb Surgery: A Narrative Review

Abstract

Olecranon autografting is a regional bone-graft option for upper-limb reconstruction when moderate amounts of cancellous or cortico-cancellous bone are needed without creating a second operative field. This narrative review examines the graft’s anatomical characteristics, open and trephine harvest techniques, clinical applications, donor-site morbidity, and functional results. Cadaveric studies indicate that the olecranon can provide approximately 3.9 cm³ of cancellous bone and a cortico-cancellous segment with useful tubular dimensions, while biomechanical work suggests that proximal and dorsal cortical windows provide similar graft quantities and fracture resistance. Clinical use is concentrated in hand and wrist reconstruction, particularly scaphoid and distal phalangeal nonunion, with additional reports involving metacarpal defects, distal interphalangeal revision arthrodesis, and other upper-limb bone gaps. The available clinical evidence is dominated by retrospective cohorts, case series, and technical reports. These studies generally describe high recipient-site union and low donor-site morbidity, but the evidence is vulnerable to selection bias, inconsistent outcome definitions, heterogeneous recipient pathology, and limited comparator data. Trephine harvest appears to reduce early pain, operative time, and scar burden compared with open harvest, although the durability of these advantages and their relevance to larger grafts remain uncertain. Future research should standardise graft-volume reporting, define safe harvest boundaries, and compare olecranon grafts prospectively with distal-radius and iliac-crest alternatives.