Iliac Crest Bone Graft Harvesting: Prospective Study Of Various Techniques And Donor Site Morbidity

Background Harvesting autograft bone from the ilium is not without complications. When cases are reported in follow-ups, investigators usually concentrate upon treatment outcome of the principle problems and not on the donor site morbidity from harvesting a bone graft. The purpose of our study is to assess the complications related to bone grafting site of iliac crest, simultaneously evaluation and assessment of various techniques used for harvesting the bone graft from the iliac crest. Material and methods 56 patients were included in our study, which fulfilled the criteria of at least 6 months follow up. Bone graft was harvested from anterior or posterior iliac crest by wolfe-kawamoto’s, outer cortex, inner cortex and tricortical graft harvesting and trephine techniques. Results – Graft harvested from anterior crest in 49 cases (88%), posterior crest in 6 cases (11%) and bilateral anterior crest in 1 (1.8%). Graft harvesting techniqueswolfe-kaamoto’s used in 15(27%), outer cortex in 30 patients (55%), inner cortex in 1(1.8%), and tricortical in 8(14%) and trephine method in 1(1.8%) patient. Average amount of graft harvested from posterior cortex was more compared to anterior crest (13.3/9.6 gm). Donor site complicationsinfection rate 7.2% (superficial3 patients, deep1 patient), hematoma 1.8% (n-1), cutaneous nerve injury 14.3% (temporary loss of sensation 3, residual loss in 5 patients), donor site pain 10.6% (temporary5, residual1) and direct incomplete hernia in 1 patient (1.8%). Total donor site morbidity was (35.6%)[minor complications in 21.4%(n-12) and major complications in 14.2%(n-8)]. ConclusionHarvesting bone graft from iliac crest is not without complications. Injury to the cutaneous nerve around the crest constitutes the major component of morbidity after iliac crest bone graft harvesting.