Iliac crest autograft versus alternative constructs for. Alternative bone graft harvest sites can be casespecific. It allows the harvesting of cancellous bone, corticocancellous bone strips, or even tricortical bone, as appropriate. However, at present the iliac crest bone graft is the gold standard against which new techniques must be measured. Definition this procedure will take place when a patient has need for bone graft for spinal surgery.
Depending on the anatomical situation, up to three graft cylinders can be harvested from this site. Iliac crest bone harvest may leave a permanent pain at the operative site. Minimal access iliac crest cortical cancellous bone graft. Autologous bone grafts harvested from the iliac crest are commonly used in reconstructive orthopaedic surgery.
A retrospective analysis of 372 adult patients who had undergone anterior iliac bone graft harvesting from may 2006 to may 2011. Repetitive posterior iliac crest autograft harvest resulting. The grafts obtained in this manner are bi and not tri cortical, and always of sufficient size in order to fit. Autogenous bone grafting is often done in orthopaedic surgery for a variety of conditions. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a latarjet procedure is still controversial. Iliac crest bone harvesting may leave lasting pain bone grafts, attaching bone to bone, are a frequently performed surgery in the united states. Nandyala alejandro marquezlara junyoung ahn kern singh definition the use of autogenous bone graft is considered by most surgeons to be the gold standard for achieving fusion in the spine. With the assistance of a reference librarian, a computerized literature search of the national library of medicine was done for the years 1966 and 1997. Besides the posterior iliac crest, one major donor site is the area around the internal lip of the iliac crest.
Iliac crest pain, fracture, bone graft, location and anatomy. Iliac crest bone graft adult, peds medical staff affairs. Jan 27, 2016 the composite tissues available for freetissue transfer reconstruction of bone containing defects of the head and neck are from the fibula, iliac crest, scapula, radius, and metatarsal. Fracture of anterior iliac crest following bone graft harvest. Original source unknown, but an excellent video detailing the technique of harvesting iliac crest bone fair use notice this video may contain ed material.
Bone marrow aspiration techniques anterior iliac crest cont. Sep 04, 2017 a complete step by step technique of the bone graft harvesting from the iliac crest. Iliac crest bone graft harvesting musculoskeletal key. Prospective study of various techniques and donor site morbidity 2 of 7 most of the patients were between 2030 age group n22. An iliac crestinternal oblique osteomusculocutaneous free flap was harvested without a skin paddle. However, it is only in rare cases that iliac crest bone graft technique leads to a fracture of the iliac wing. Complications of iliac crest bone graft harvesting. Maximum quantity of bone available for harvest from the. Continuous infusion of ropivacaine for pain relief after. Autologous or autogenous bone grafting involves utilizing bone obtained from the same individual receiving the graft. Many of them are autologous, where a piece of bone is taken from the person who is getting the bone graft auto self. These three posterior harvest sites did not show any significant deviation from the mean of the anterior grafts and were thus included in the analysis. The iliac crest is also considered the most ideal donor site for bone grafting when a large quantity of bone is needed. The gold standard for harvesting cancellous bone has long been the iliac crest site 1516.
For procedures requiring a bone graft involving head and neck. N2 the borders of the posterior ilium are the iliac crest superiorly, the posterior superior iliac spine psis posteriorly, and the greater sciatic notch inferiorly. The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription. Approximately 5060 ml of bone marrow may be harvested from the iliac crest fairly easily by this method with only one skin incision created above the iliac crest. Lateral cutaneous nerve was involved in 6 patients who had undergone graft harvesting from anterior cortex, out of them only 3 patients had residual. Orthopedics today when performing an iliac crest bone graft for orthopedic trauma reconstruction, an anterior harvesting technique resulted in minimal pain, according to a retrospective study. The orthopaedic surgeon should be aware of this detrimental complication associated with extensive or repeated posterior iliac crest graft harvest. The patient is intubated and positioned supine on the operating room table.
A serious concern with this technique is that there are no biomechanical data on the implantfree graft s reaction to early shear force. In the future, new technologies may limit the need for autogenous bone donation and limit the complications due to bone graft harvest. Shoulder surgery and iliac bone graft harvest are both procedures that are associated with considerable postoperative pain and discomfort. Fractures of the iliac crest following graft procedures have been reported in the past. We describe a technique and case report of iliac crest autograft harvest using a trapdoor technique. Mar 19, 2020 an iliac crest graft is a bone graft in which a piece of bone is removed from the upper region of the pelvis of a patient and implanted into another site within that patients body. There have been modifications since the technique was described 514. The anterior iliac crest aic, posterior iliac crest pic, and proximal tibia pt are the 3 most popular sites of autogenous bone harvesting for use in the reconstruction of large bony defects, 1 with approximately 200,000 autogenous bone grafts harvested each year in the united states. Case report a 35 yearsold systematically healthy male. Complication of anterior iliac bone graft harvesting in 372.
A complete step by step technique of the bone graft harvesting from the iliac crest. A twoyear audit of nonvascularized iliac crest bone graft for mandibular reconstruction. The iliac crest has a large amount of red bone marrow, and thus it is the site of bone marrow harvests from both sides to collect the stem cells used in bone marrow transplantation. We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. Bone can be harvested from nonessential bones, such as from the iliac crest, or more commonly in oral and maxillofacial surgery, from the mandibular symphysis chin area or anterior mandibular ramus the coronoid process. The quality of bone is superior to other sites and also the. For harvesting in a prone position, the patient is intubated supine and then positioned prone, with 210 of reverse hip flexion. A third study utilized cagemeshautograft cancellous bone plate in 27 patients versus iliac autograft spacerplate in 27 patients, determining that surgical costs were comparable. The technique for bone graft harvesting from the iliac crest should respect a number of biomechanical principles. Iliac crest bonemuscle transfer in periacetabular osteotomy. Anterior iliac crest bone graft is a surgical procedure for harvesting a cortical, cancellous, or corticocancellous block graft from the anterior ilium. Iliac crest definition of iliac crest by medical dictionary. We describe a technique for arthroscopic anterior glenoid augmentation using iliac crest bone graft that does not violate the subscapularis, by creating a far anteriormedial portal that traverses superior to the subscapularis and lateral to the conjoint tendon.
Techniques and complications of bone graft harvesting. Arthroscopic iliac crest bone block for reconstruction of the. These bone grafts are called autografts and are used primarily to replace bone lost to injury or illness. Autogenous bone graft can be used at any spinal level, anterior or posterior. Prospective study of various techniques and donor site morbidity 4 of 7 them loss of sensation was temporary in 5. All of the rest had an anterior iliac crest bone graft donor site. Allarthroscopic implantfree iliac crest bone grafting. This clinical report presents the reconstruction of severe maxillary alveolar bone deficiency with anterior iliac crest bone grafting using combined spinal epidural anesthesia csea which is a type of nab technique. Jan 18, 2015 posterior iliac crest bone graft picbg harvesting technique posterior iliac approach. Fracture of the iliac crest following bone grafting. The vascularized iliac bone flap was fixed to the adjacent maxilla, the remaining lateral nasal bones, and the remnant. This article reports on a surgical technique for periacetabular osteotomy that transfers an iliac bone segment with attached muscle, completely preserving the integrity of the proximal tensor.
According to the literature, the fracture of the iliac crest after bone harvesting should not be considered a frequent complication. This article describes the iliac crest flap, which is based on the deep circumflex iliac artery dcia. Arthroscopic iliac crest bone grafting to the anterior. Iliac crest internal oblique osteomusculocutaneous free flap. Anterior iliac crest bone graft harvesting results in minimal. May 27, 2011 operative stress from iliac crest graft method can also result in fractures of the ilium. The iliac crest is currently the most common donor site. In the icbg cohort, autologous bone graft was harvested from the iliac crest contralateral to the site of decompression using a minimally invasive technique 20. This procedure is to allow the advanced health practitioner ahp to safely perform an iliac crest bone graft. A hip roll is placed under the pelvis to accentuate the anterior iliac crest anatomy. Some authors have suggested that the iliac crest as donor site produce an unacceptably high degree of postoperative morbidity such as pain, functional disorders, hemorrhage, visible scar, contour deformity and sensory loss.
Iliac wing fracture following graft harvesting from the. The debris generated during intramedullary reaming, harvested with use of the ria technique, and the bone graft harvested from the iliac crest possessed a similar transcriptional profile for genes. Jul 29, 2017 original source unknown, but an excellent video detailing the technique of harvesting iliac crest bone fair use notice this video may contain ed material. So far, the literature has indicated 50 cases of iliac crest fractures after bone harvesting intervention, and 28 cases among these are due to harvesting from the anterior part of the iliac crest. This is the most common site for autologous bone graft.
Introductionintroduction contemporary oral and maxillofacialcontemporary oral and maxillofacial surgeons need bone grafting techniques tosurgeons need bone grafting techniques to satisfy patient needs in trauma, pathology,satisfy patient needs in trauma, pathology, reconstructive surgery, and. Many alternatives exist for bone grafting in foot and ankle surgery. When the sequential drilling is completed, a straight osteotome stille is used for completing the bone dissection within the iliac crest and the graft is gently elevated from the iliac bone in order to avoid undue fracturing. Harvesting from the posterior iliac region can be performed with the patient positioned either prone or in the lateral position.
The graft is passed through this portal and secured with rigid fixation. Is miniinvasive technique for iliac crest harvesting an. The iliac crest was fashioned to recreate the nasal piriform aperture and the inferior orbital rim figure 2 and figure 3. Jul 24, 2016 iliac crest bone graft harvesting sreeharsha v. A skin incision is made over the anterior iliac crest, and an incision is made into the periosteum overlying the outer aspect of the crest. The iliac crest is currently the most common donor site for obtaining autogenous bone graft. This technique provides an excellent alternative source of bone while minimizing complications associated with some other iliac crest bone graft harvest techniques.
Autologous bone harvesting from the anterior iliac crest represents the gold standard harvesting technique. Most common indication for iliac crest bone graft harvesting was fresh trauma which was 54%n30 followed by nonunion 25%n14, tumor reconstruction 7. Arrington ed1, smith wj, chambers hg, bucknell al, davino na. Anterior iliac crest bone graft harvesting springerlink.