Cancellous Autograft Transfer From Screw‐Hole to the Proximal Tibial Osteotomy Opening Gap for Early Bone Consolidation Without Donor‐Site Morbidity

Abstract Autologous bone grafting can enhance gap healing after medial open‐wedge high tibial osteotomy and open‐wedge distal tibial tuberosity osteotomy, but iliac‐crest harvest adds donor‐site morbidity and is therefore not routinely performed. We describe a bone autografting technique, termed cancellous autograft transfer from screw‐hole, which leverages routinely drilled locking plate screw pilot holes as a local donor source to obtain cancellous autograft without a separate donor‐site or additional incision. During plate fixation, cancellous bone is cored from the proximal screw pilot holes using a coring device (4.9 mm outer diameter, 4.5 mm inner lumen), and each harvested hole is then secured with a 5.5 mm locking screw. The cylindrical cores are transferred into the hinge‐side portion of the opening gap. In the initial 8 cases, mean cumulative core length is approximately 80 mm (range, 60‐130 mm), and computed tomography at 1 month shows early consolidation with bony bridging despite a lateral hinge fracture. The cancellous autograft transfer from screw‐hole technique is a simple adjunct to plate fixation that provides local cancellous autograft while fully avoiding donor‐site morbidity.