Delayed primary bone grafting in the hand and wrist after traumatic bone loss.

Seventeen patients had 21 bone graft operations as part of the overall delayed primary management of hand and wrist wounds. All bone graftings were performed within 10 days of injury. Internal or external fixation was used in all cases, and all wounds healed without infection. Complications included a fibrous union at one bone graft juncture and one malunion. Follow-up was from 3 months to 7 years. Successful delayed primary bone grafting requires a well-decompressed and surgically-clean wound, good blood supply, adequate fixation, and secure soft-tissue cover. If these conditions cannot be met, bone grafting should be deferred and performed in the conventional manner. The advantages of delayed primary bone grafting are: primary bone healing, a shorter rehabilitation period, fewer operations, avoidance of wound contracture, and bone grafting in a well-vascularized scar-free bed.