Optimizing Safety of Iliac Bone Harvest Using an Acumed Drill: A Simulated Radiographic Study of 100 Patients

Stranix, John T.; Cuzzone, Daniel; Ly, Catherine; Topilow, Nicole; Runyan, Christopher M.; Ream, Justin; Flores, Roberto L.

doi:10.1597/15-341

Cited by 6 publications

(10 citation statements)

References 10 publications

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“…They postulated that limiting the trephine depth to 3 cm reduces the risk of visceral injury based on their CT findings. 8 Caminiti et al corroborate these results, stating an increased risk of fracture to the inner or outer table with trephine depth more than 30 mm. 7 Missiuna et al describe the use of a Steinman pin as a trochar inserted into the iliac crest, over which they guided the circular trephine during bone graft harvest.…”

Section: Volume and Type Of Harvested Bonementioning

confidence: 80%

“…25 Stranix et al assessed the potential volume of cancellous bone graft harvest based on CT measurements. 8 The maximum cancellous volume they projected that could be safely harvested increased with age, with 12 cc in 8-year-olds, to 17 cc in 12-year-olds, using a 42 mm drill bit. 8 Despite these predictions, such harvest yields were not corroborated in clinical studies.…”

Section: Volume and Type Of Harvested Bonementioning

confidence: 99%

“…8 The maximum cancellous volume they projected that could be safely harvested increased with age, with 12 cc in 8-year-olds, to 17 cc in 12-year-olds, using a 42 mm drill bit. 8 Despite these predictions, such harvest yields were not corroborated in clinical studies. Caminiti et al performed a study using 4 mm motorized trephine in adult cadavers, as well as 11 live patients.…”

Section: Volume and Type Of Harvested Bonementioning

confidence: 99%

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Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques

et al. 2022

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Background: In the course of developing a standardized pathway for alveolar cleft repair, we conducted a systematic review comparing minimally invasive trephine with conventional open technique for iliac crest bone graft harvest in a pediatric population. Methods: A systematic review was conducted of studies comparing open with minimally invasive trephine techniques in pediatric populations undergoing alveolar cleft repair. Exclusion criteria included reviews, case series, editorials, abstracts, and those with adult-only populations. Data were compiled with outcome variables selected a priori. Results: Of 422 manuscripts screened, five met criteria. These comprised 257 patients (116 open, 141 trephine). Average age was 11 years. Patients undergoing trephine harvest had reduced length of stay (1.0-5.0 days trephine vs 1.25-5.4 days open), time to unassisted ambulation (16-46 hours vs 20-67 hours open), and less postoperative narcotic use (0.31 mg/kg vs 1.64 mg/kg IV morphine). Volume of cancellous bone was reported as 2.53 mL for open versus 1.22 mL for trephine in one study, and trephine graft was supplemented with demineralized bone in 54% of cases in another study. The use of anesthetic adjuncts was inconsistent but had a significant effect on postoperative pain and ambulation. Conclusions: Compared to open techniques, the minimally invasive trephine bone graft harvest is associated with a shorter time to discharge, slightly lower infection rates, and reduced opioid use. The possible benefits of trephine harvest must however be balanced against the risk of insufficient graft harvest. Finally, the choice of perioperative analgesic adjuncts significantly impacts patient outcomes regardless of the technique employed.

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Section: Volume and Type Of Harvested Bonementioning

confidence: 80%

Section: Volume and Type Of Harvested Bonementioning

confidence: 99%

Section: Volume and Type Of Harvested Bonementioning

confidence: 99%

See 1 more Smart Citation

Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques

et al. 2022

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“…Six papers studied simulation 37-42 , with the different types summarized effectively by Vanikipuram et al 42 . These studies showed that simulation can successfully be used to reduce plunging depth in trainee surgeons 38,39 and that computer-based simulation was found to provide effective and transferable skills for inexperienced surgeons 40,41 .…”

Section: Resultsmentioning

confidence: 99%

Power-Tool Use in Orthopaedic Surgery

et al. 2021

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Background:Power tools are an integral part of orthopaedic surgery but have the capacity to cause iatrogenic injury. With this systematic review, we aimed to investigate the prevalence of iatrogenic injury due to the use of power tools in orthopaedic surgery and to discuss the current methods that can be used to reduce injury.Methods:We performed a systematic review of English-language studies related to power tools and iatrogenic injuries using a keyword search in MEDLINE, Embase, PubMed, and Scopus databases. Exclusion criteria included injuries related to cast-saw use, temperature-induced damage, and complications not clearly related to power-tool use.Results:A total of 3,694 abstracts were retrieved, and 88 studies were included in the final analysis. Few studies and individual case reports looked directly at the prevalence of injury due to power tools. These included 2 studies looking at the frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%), 2 studies investigating the frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%), and 4 studies investigating vascular injury during total joint arthroplasty (1 study involving 138 vascular injuries in 124 patients, 2 studies noting 0.13% and 0.1% incidence, and 1 questionnaire sent electronically to surgeons). There are multiple methods for preventing damage during power-tool use. These include the use of robotics and simulation, specific drill settings, and real-time feedback techniques such as spectroscopy and electromyography.Conclusions:Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests that the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations, the use of advanced technologies to reduce the chance of iatrogenic injury should be considered.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…& N.P.). Cancelous bone graft was harvested from either iliac crest, however dissection was minimized via use of the 7 mm Acumed reamer system (Acumed, Hillsboro, OR) 5,6 and prior to wound closure all patients received local infiltration of liposomal bupivacaine. Following bone graft harvest, the recipient site was prepared, the bone graft placed, and the wound closed in the usual fashion.…”

Section: Methodsmentioning

confidence: 99%

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Coombs,

Patel,

Kochenour

et al. 2023

FACE

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Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

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Optimizing Safety of Iliac Bone Harvest Using an Acumed Drill: A Simulated Radiographic Study of 100 Patients

Abstract: Acumed assisted iliac crest bone graft harvest is a safe technique in which substantial amount of cancellous bone can be obtained. The low risk of bowel perforation can be further minimized by limiting the depth of drill bit penetration to less than 3 cm.

Cited by 6 publications

References 10 publications

Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques

Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques

Power-Tool Use in Orthopaedic Surgery

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

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