Sat., 10/16/10 Polytrauma & Femur, Paper #74, 11:15 am OTA-2010
Does Long Term Donor Site Morbidity after Anterior Iliac Crest Bone Graft Harvesting Exist?
Sangmin Ryan Shin, MD; Paul Tornetta, III, MD;
Boston University Medical Center, Boston, Massachusetts, USA
Background/Purpose: High rates of donor-site morbidity after harvest of posterior iliac crest bone grafts have been reported in patients undergoing spine procedures. The purpose of this study is to evaluate long-term donor-site morbidity associated with anterior iliac crest bone graft harvesting via the inner table for orthopaedic trauma reconstructions.
Methods: The medical records of 46 consecutive patients who had undergone iliac crest bone graft with anterior harvesting technique by a single orthopaedic traumatologist over a 7-year period were reviewed. All grafts were taken by removing the inner table of the ilium from 2 cm posterior to the anterior superior iliac spine for a 6- to 8-cm distance after releasing the abdominal musculature, allowing harvesting of cancellous bone and corticocancellous strips. The average bone obtained was 40 cc. The abductor insertion was left intact and the external contour of the ilium remained unaffected. Patients’ demographic characteristics, preoperative diagnoses, procedures, and postoperative wound complications were recorded. Questionnaires (adapted from a published questionnaire) pertaining to duration and severity of pain assessed with a visual analog scale (VAS), functional limitations, scar numbness, thigh numbness (in lateral femoral cutaneous nerve distribution), scar tenderness, cosmetic satisfaction, and whether the patient would consent to a future iliac crest bone graft procedure if needed were used to evaluate the long-term morbidity of the bone graft harvest.
Results: 30 patients (20 men and 10 women; average age, 46 years [range, 29-65 years]) were evaluated at mean follow-up of 7 years after index anterior iliac bone graft harvesting for nonunion (24) or fusion for posttraumatic arthrosis (6). There were no postoperative wound complications. Four (13%) of the 30 patients reported pain lasting more than 2 weeks after the harvest (2 weeks, 3 weeks, 2 months, and 6 months). Their average VAS was 7.5 (range, 6-8) during that time. However, no patient had any pain at final follow-up (VAS = 0 for all patients). Three of the four patients who had pain for more than 2 weeks after graft harvest expressed that they would not elect to have another bone graft and would seek alternative graft sources. All other patients would consent to another bone graft if recommended. Three patients (10%) reported some scar numbness; however, none complained of thigh numbness (lateral femoral cutaneous nerve). 28 patients (93.3%) were satisfied with the cosmetic result. Finally, no patient had any limitations in activity related to the harvest site.
Conclusions: Anterior inner table iliac graft harvesting resulted in minimal morbidity and no pain or functional limitations at an average of 7 years after the index procedure. Four of 30 patients (13%) had pain that lasted more than 2 weeks and three of these four patients would be resistant to another bone graft due only to the postoperative pain. This technique has lower long-term consequences than prior reports of posterior graft sites.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.