Fracture Channel Grafting: A Single-Incision Technique for Autologous Bone Harvest through the Fracture Site in Humeral Shaft Fixation

AO/OTA 12B wedge-type and 12C multifragmentary fractures of the humeral shaft are characterized by varying degrees of comminution and cortical disruption. Although many humeral shaft fractures can be managed nonoperatively, surgical fixation is indicated in selected cases based on fracture characteristics and patient factors. In fractures treated with open reduction and internal fixation (ORIF), mechanical stability is typically restored, and biological factors such as comminution, cortical discontinuity, and local devascularization may influence healing. In such situations, surgeons may consider biological augmentation at the time of fixation. Autologous cancellous bone grafting remains a commonly used method for biological augmentation. However, conventional harvest techniques, such as iliac crest grafting, require additional surgical exposure and are associated with donor site morbidity. Upper limb donor sites, although associated with lower morbidity, still necessitate separate incisions and increased operative time. When only a moderate volume of the cancellous graft is required, a simpler method of harvest may be desirable. Fracture channel grafting is a single-incision technique that allows cancellous bone to be harvested through the existing fracture site during surgical fixation. A curette is introduced through the standard surgical exposure into the proximal intramedullary canal and advanced toward the metaphyseal region of the proximal humerus under fluoroscopic guidance. Circumferential curettage is then performed to obtain a cancellous graft. This approach utilizes the existing surgical field and avoids the need for a separate donor site. The purpose of this study was to describe the fracture channel grafting technique and to report its feasibility and early clinical outcomes in a prospective series of patients undergoing ORIF for humeral shaft fractures.