Harvesting Autogenous Cancellous Bone Graft from the Anterior Iliac Crest

Abstract

A utograft bone graft harvest is an important surgical technique in the armamentarium of the orthopaedic surgeon. The iliac crest can provide a robust amount of bone graft, but using it carries a risk of complications including neurologic injury, gait disturbance, sensory dysesthesia, and ilium fracture. We present a surgical technical involving harvest of cancellous bone graft from the anterior iliac crest that minimizes the complication profile associated with tricortical bone graft harvest. It should be noted that there are differences between the outcomes of anterior and posterior crest harvests. Anterior autograft harvest is associated with a higher complication rate, with more iliac wing fractures, postoperative hematomas, and sensory disturbances. The posterior approach, however, is associated with more postoperative pain than the anterior approach, with the patient often experiencing more pain from the harvest than from the procedure itself. The allcancellous iliac crest bone graft harvest provides the benefit of a large quantity of autogenous bone for various procedures, ranging from spinal fusion to osseous reconstruction. The major steps of this procedure are (1) offset of the surgical incision, (2) exposure of the iliac crest while avoiding neurologic structures, (3) identifying the location of and performing a corticotomy of the iliac crest, (4) harvesting the cancellous bone graft using curets, (5) obtaining hemostasis, and (6) performing a layered closure. The postoperative course entails immediate weight-bearing as tolerated. There is a potential for complications, which are discussed at the individual points of concern during this video.

Autologous Iliac Bone Graft Compared with Biphasic Hydroxyapatite and Calcium Sulfate Cement for the Treatment of Bone Defects in Tibial Plateau Fractures

“…The bone defect remaining after the reduction of the depressed articular fragments was reconstructed according to the result of randomization either with autologous iliac bone graft or with synthetic bone-graft substitute. In the first group, autologous bone grafts were harvested from the ipsilateral anterior part of the iliac crest following a well-established surgical technique currently presented by Shaw et al 14 .…”

Commonly Utilized Non Vascularised Bone Grafts in Maxillofacial Reconstruction

“…The important anatomical landmarks that should be considered during surgery are the anterior superior iliac spine (ASIS) and iliac tubercle, which is 6 cm posterior to the ASIS. The iliac crest receives its blood supply from the deep circumflex iliac artery, a branch of the internal iliac artery and the most common bleeding source during surgery [7,20,21]. Sensory nerves that must be protected are iliohypogastric nerve and lateral femoral cutaneous nerve.…”

<p>Iliac Bone Harvesting Techniques for Bone Reconstruction. Comparative Study Between Tricortical Bone Harvesting vs Trapdoor Technique</p>

“…By contrast, tricortical iliac bone harvesting causes numerous soft tissue peeling in the inner and outer areas of donor sites and cancellous bone exposure, which may increase donor site bleeding. Damage to the donor sites and soft tissue collapses limit control over hematoma, which may potentially spread to locations such as the gluteal and iliacus muscles 11 and cause heterotopic ossification and pain.…”