Quantitative Analysis of Cancellous Bone Graft Available from the Greater Trochanter

Abstract

To quantify the amount of cancellous bone graft available from the greater trochanteric region, 20 paired iliac crest-proximal femur specimens were harvested and compared in 10 adult pelvises. A 1.3 x 1.3-cm cortical window was made in the lateral aspect of the proximal femur 2 cm distal from the tip of the greater trochanter. Cancellous bone evacuation was performed by curettage. The extent of harvest was mechanically limited by the medial wall of the trochanter and by curette impingement on the margins of the cortical window. The graft was quantitated after maximal digital compression in a 10-ml syringe and compared with cancellous graft obtained from the paired anterior iliac crest. The average compressed volume of cancellous bone harvested from the greater trochanter was 6.5 ml (range, 4.2-9.6 ml). The average iliac crest cancellous bone volume was 6.0 ml (range, 2.7-8.8 ml). Differences in graft volume between the anterior iliac crest and the trochanter were not statistically significant. The resulting defect in the proximal femur remained isolated to the trochanteric region. In this study, we demonstrate that cancellous bone is available from the greater trochanteric region in an amount similar to that available from the anterior iliac crest. We also show that it is obtainable in a reproducible manner. Our clinical experience of over 100 cases has demonstrated acceptable morbidity associated with this technique. The greater trochanteric region may be used as a secondary source of autogenous cancellous bone graft when specific procedures demand more bone graft than available from the iliac crest alone, or in patients who have had previous iliac crest graft harvest.

Tibial versus iliac bone grafts: a comparative examination in 15 freshly preserved adult cadavers

“…The primary purpose of this investigation was to scientifically examine the tibial in comparison to the iliac donor site regarding attainable graft amount and histological bone density. Numerous studies have discussed the properties of either iliac or tibial grafts (Kraut & Judy 1993;Lindberg et al 1996;Caminiti et al 1999;Lee 2003;Aboul-Hosn et al 2006;Tiwana et al 2006), but literature is lacking in examinations with an intraindividual comparison of these two donor sites. As second important issue the characteristics of both grafts themselves were systematically analyzed in regard to age-dependence and sex specifity.…”

“…A possible reason for the comparatively small volumes in our collective could be older age of the cadavers (76.8 years), but on the other hand neither the graft volumes for the tibial ( r =−0.06) nor for the iliac grafts ( r =0.402) exhibit age dependence in the examined age interval. Furthermore, our applied measuring method consisting of volume displacement of water could play an important role, since, in contrast to the simple determination of volume by a syringe or a measuring jug (Lindberg et al 1996), the hollow spaces between the bone pieces do not affect the measured volume. Nonetheless, bone amount obtained from each donor site is sufficient to perform sinus lifting, one of the most important indications for harvesting autogenous bone grafts, at least unilaterally (Lee 2003).…”

Morbidity Associated With Anterior Iliac Crest Bone Grafting in Foot and Ankle Surgery

“…The ipsilateral greater trochanter, 10,15 distal tibia, 17 distal femur, 13 proximal tibia, 2,16 and calcaneus 7 also have been used as alternative graft harvest sites and provide other options for obtaining autogenous grafts.…”

Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach

“…3a). After that, the cancellous bone graft was placed into a 10 ml syringe and compressed with double thumb pressure 13 . The volume of this measurement was recorded as compressed volume (Fig.…”