Anterior iliac crest bone graft is a surgical procedure for harvesting a cortical, cancellous, or corticocancellous block graft from the anterior ilium. Harvesting from the posterior iliac region can be performed with the patient positioned either prone or in the lateral position. On physical examination, a well healed incision overlying the left iliac crest was noted. Allarthroscopic implantfree iliac crest bone grafting. Cancellous bone graft material is the most commonly used iliac crest bone graft icbg material because of its regeneration properties reflecting. To describe a modified technique for harvesting cortical bone graft from the anterior iliac crest. Unusual complications at iliac crest bone graft donor site. The patient was treated nonoperatively with a good result. Surgical techniques for autologous bone harvesting from the iliac. The j bone graft technique is characterized by a temporary horizontal split of the subscapularis and capsule, monocortical incomplete osteotomy of the anterior glenoid neck, implantfree pressfit insertion of a jshaped bicortical bone graft harvested from the iliac crest, surface shaping of the graft with an electrical burr to restore the. It allows the harvesting of cancellous bone, corticocancellous bone strips, or even.
We report a case of liver herniation that occurred following harvesting of a corticocancellous bone graft from the right anterior iliac crest in a patient who had already undergone surgery for. The patient is intubated and positioned supine on the operating room table. This paper describes an iliac wing fracture after bone graft was harvested from the iliac crest. In larger reconstruction cases, the volume of bone available from the posterior. Posterior iliac crest for the posterior iliac crest and other anatomic locations covered subsequently, excluding locationspecific detail, all aspects of the bone marrow aspiration technique are identical to those described in the preceding section. This article summarizes the classification of nonunions and the use of iliac crest autogenous bone grafting, the standard against which any new technique must be measured. An iliac crest graft is a bone graft in which a piece of bone is removed from the upper region of the pelvis of a patient and implanted into another site within that patients body. Alternative bone graft harvest sites can be casespecific. Fracture of anterior iliac crest following bone graft harvest.
We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. Anterior iliac crest bone graft atlas of operative oral. Neuroaxial blockade techniques may be a useful alternative to eliminate general anesthesia related challenges of anterior iliac crest bone grafting procedures. Apply local pressure to the harvest site and close the. Iliac crest autogenous bone grafting, although associated with donor site complications, continues to be a necessary part of the treatment of many nonunions. Pdf reconstruction of anterior iliac crest bone graft donor. Iliac crest bone grafting for the management of anterior. We describe a technique for arthroscopic anterior glenoid augmentation using iliac crest bone graft that does not violate the subscapularis, by creating a far anteriormedial portal that traverses superior to the subscapularis and lateral to the conjoint tendon. Can be harvested from anterior or posterior iliac crest. Summary anterior iliac crest bone graft is a surgical procedure for harvesting a cortical, cancellous, or corticocancellous block graft from the. Prospective study of various techniques and donor site morbidity 4 of 7 them loss of sensation was temporary in 5. A twoyear audit of nonvascularized iliac crest bone graft. A twoyear audit of nonvascularized iliac crest bone graft for mandibular reconstruction.
Fracture of the iliac crest following bone grafting. Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. When the appropriate length of iliac crest is isolated, the osteotomies can be performed. Techniques and complications of bone graft harvesting. Jan 18, 2015 posterior iliac crest bone graft picbg harvesting technique posterior iliac approach. A skin incision is made over the anterior iliac crest, and an incision is made into the periosteum overlying the outer aspect of the crest. A hip roll is placed under the pelvis to accentuate the anterior iliac crest. Fracture of anterior iliac crest following bone graft. A hip roll is placed under the pelvis to accentuate the anterior iliac crest anatomy. May 27, 2011 operative stress from iliac crest graft method can also result in fractures of the ilium. However, this locally obtained bone graft has exhibited questionable osteoconductive properties, often necessitating the addition of biologics to improve fusion rates. Dawson j, kiner d, gardner w ii, swafford r, nowotarski pj.
Understanding bone safety zones during bone marrow. Clinically, 18 patients with adfnbd were included in this retrospective study and were treated with a combination of j bone graft and dp. The proximity of the harvest site to the anterosuperior iliac spine, as well as the depth of the cut made in the bone, are of particular note in this regard. After incising the skin and subcutaneous layers, sharply. The purpose of this surgical technique is to provide a method of minimally invasive icbg harvesting to. However, it is only in rare cases that iliac crest bone graft technique leads to a fracture of the iliac wing.
Tips and tricks in harvesting of bone from the iliac crest. Vascularized bone graft technically challenging with quicker union and cell preservation examples include. Iliac crest bone graft icbg has previously been reported to be a safe and efficacious source for bone graft. Approximately 5060 ml of bone marrow may be harvested from the iliac crest fairly easily by this method with only one skin incision created above the iliac crest. Furthermore, the use of autologous bone graft, in particular iliac crest bone graft, has provided reliable clinical results. The iliac crest grafting has some complications that should be known by. Posterior iliac crest bone graft atlas of operative oral. Reconstruction of anterior iliac crest bone graft donor sites.
The modified sauvekapandji procedure is an effective technique to restore druj function, which is performed as an ulnar support arthroplasty. Fig 1 is a bony prominence arising from the iliac crest just posterior to the asis. The technique for bone graft harvesting from the iliac crest should respect a number of biomechanical principles. Bone graft harvest menu wheeless textbook of orthopaedics. Any information contained in this pdf file is automatically generated from digital material. Reconstruction of iliac crest defect after autogenous. Autologous bone harvesting from the anterior iliac crest represents the gold standard harvesting technique. Full thickness bicortical graft is optional, unicortical bone preserves the contour of the iliac crest. Apply local pressure to the harvest site and close the incision with one simple suture using a 40 absorbable. Harvesting bone graft from anterior iliac crest and its. For harvesting in a prone position, the patient is intubated supine and then positioned prone, with 210 of reverse hip flexion.
A serious concern with this technique is that there are no biomechanical data on the implantfree graft s reaction to early shear force. After bone harvesting from the anterior iliac crest, patients complained about persistent pain, superficial skin sensitivity, gait disturbance, the need for the use of crutches, bleeding, infection, pelvic fractures 4, 7. The aim of this study was to compare the stability of simultaneously placed dental implants with autologous bone grafts harvested from either the iliac crest or the intraoral jaw bone for severely atrophic alveolar ridges. A twoyear audit of nonvascularized iliac crest bone. The volume of the bone graft depended on the volume of the tumor. Introductionintroduction contemporary oral and maxillofacialcontemporary oral and maxillofacial surgeons need bone grafting techniques tosurgeons need bone grafting techniques to satisfy patient needs in trauma, pathology,satisfy patient needs in trauma, pathology. Cancellous and corticocancellous bone graft is commonly retrieved from a site just posterior. Iliac wing fracture following graft harvesting from the. Lateral cutaneous nerve was involved in 6 patients who had undergone graft harvesting from anterior cortex, out of them only 3 patients had residual. Learn more about possible causes of iliac crest pain and the types of exercises used to treat it. Autologous or autogenous bone grafting involves utilizing bone obtained from the same individual receiving the graft. A retrospective study of iliac crest bone grafting techniques.
Arthroscopic iliac crest bone block for reconstruction of. The posterior iliac crest offers a rich source of bone. Basic knowledge of bone grafting 15 heterogeneous grafts. Iliac crest pain, fracture, bone graft, location and anatomy.
Jul 29, 2017 original source unknown, but an excellent video detailing the technique of harvesting iliac crest bone fair use notice this video may contain ed material. Many alternatives exist for bone grafting in foot and ankle surgery. As pointed out by the authors, this complication is uncommon. Dec 30, 2015 however, the comparative longterm stability of these two autologous bone grafts have not yet been investigated. Anterior iliac crest bone graft harvesting results in. The iliac crest is currently the most common donor site for obtaining autogenous bone graft. Case report a 56yearold woman with history of bone graft extraction from the left iliac crest was presented. The technical procedure is briefly described as follows. The graft is passed through this portal and secured with rigid fixation.
Harvesting a bone graft from iliac crest may be associated with donor site complications and morbidity, wide range of. A prospective followup study of patients undergoing anterior spinal decompression and bone graft with cortical iliac crest bone. The iliac crest is a common site for harvesting bone grafts. Although the iliac crest can provide an ample amount of bone graft material and the resulting scar can be easily concealed, surgeons have long been concerned about possible complications and postoperative morbidity9, which has led to a search for minimally invasive harvesting techniques for iliac crest bone grafts9. Prospective study of various techniques and donor site morbidity 2 of 7 most of the patients were between 2030 age group n22. The bone is slightly concave on its lateral surface with three distinct ridges comprising the posterior, anterior, and inferior gluteal lines. More evidence of the low morbidity associated with. Original source unknown, but an excellent video detailing the technique of harvesting iliac crest bone fair use notice this video may contain ed material.
Autograft bone graft harvest is an important surgical technique in the armamentarium of the orthopaedic surgeon. So far, the literature has indicated 50 cases of iliac crest fractures after bone harvesting intervention, and 28 cases among these are due to harvesting from the anterior part of the iliac crest. Acute and chronic complications of intracortical iliac. In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral btwin system for fbss with a followup period of 10 years after the surgery. However, for foot and ankle procedures the proximal tibia has gained popularity as an alternative donor site due to its anatomic proximity to the primary surgical site. Orthopedics today when performing an iliac crest bone graft for orthopedic trauma reconstruction, an anterior harvesting technique resulted in minimal pain, according to a retrospective study. The debris generated during intramedullary reaming, harvested with use of the ria technique, and the bone graft harvested from the iliac crest possessed a similar transcriptional profile for genes. We describe a technique and case report of iliac crest autograft harvest using a trapdoor technique.
Among the many donor sites for harvesting autologous bone graft, the iliac crest has been the most commonly used. Bone marrow aspiration techniques anterior iliac crest cont. Comparison of minimally invasive versus conventional open. Apr 01, 2010 orthopedics abstract although autologous bone graft from the iliac crest is the gold standard for most spinal fusion applications, it is known to cause significant graft site morbidity. Albert introduction autogenous iliac crest bone graft has long been considered the gold standard source of bone graft for spinal fusion surgery, providing more rapid and reliable fusion than allograft bone in a variety. Iliac crest bone harvesting may leave lasting pain bone grafts, attaching bone to bone, are a frequently performed surgery in the united states.
Arthroscopic iliac crest bone block for reconstruction of the. Pdf autologous bone harvesting from the anterior iliac crest represents the gold standard harvesting technique. Immediate pain is the most disturbing postoperative morbidity to the patient after iliac bone grafting. A modified technique for harvesting fullthickness iliac. However, at present the iliac crest bone graft is the gold standard against which new techniques must be measured. Because of the undesirable features of autogenous and allogenic bone grafting, heterogenous bone, that is, bone from another species, was tried early in the development of bone grafting and was found to be almost always unsatisfactory. In the future, new technologies may limit the need for autogenous bone donation and limit the complications due to bone graft harvest. Many of them are autologous, where a piece of bone is taken from the person who is getting the bone graft auto self.
She did well with regard to her knee, however, she continued to complain of pain at the left iliac graft site. The reamerirrigatoraspirator as a device for harvesting bone graft compared with iliac crest bone graft. Study of various techniques and donor site morbidity. The iliac crest graft harvest was on the same side as the. Autogenous iliac crest bone graft is considered as gold standard because of it is osteoinductive, osteogenic, osteoconductive along with nonimmunogenic properties compared to other available bone graft substitutes 3.
Bone graft is essential in various orthopaedic procedures. Although these authors reported a 97% overall graft success rate with this technique, exposure of autogenous grafts to the oral environment inevitably leads to unpredictable loss of graft volume, and it is unclear how this partial loss affected. Most common indication for iliac crest bone graft harvesting was fresh trauma which was 54%n30 followed by nonunion 25%n14, tumor reconstruction 7. Posterior iliac crest bone graft picbg harvesting technique posterior iliac approach. Little information 14 documenting the risks of bone marrow aspiration in the iliac crest. Acumed bone graft harvesting surgical technique hudson fitting adaptor bg8040 bone graft punch bg8080 1 incision and dissection entry point is through a 2 cm incision located over the iliac crest, at least 3 cm posterior to the anterior superior iliac spine asis figure 1. This technique provides an excellent alternative source of bone while minimizing complications associated with some other iliac crest bone graft harvest techniques. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a latarjet procedure is still controversial. Comparison of anterior and posterior iliac crest bone grafts in terms of.
Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. Iliac crest bone harvest may leave a permanent pain at the operative site. Some kind of small or acute fractures can be cured but the risk is greater for large fractures like compound fractures. This clinical report describes the reconstruction of a severely atrophic maxilla with anterior iliac crest bone grafting using combined spinal epidural anesthesia. A summary of tips and helpful technical pearls for performing an allarthroscopic implantfree iliac crest bone grafting technique is shown in table 1. All surgical procedures were performed by the same chief surgeon. Treatment of femoral nonunion after intramedullary nail fixation using compression plating and bone grafting is a reliable technique for reducing pain, improving function, and achieving radiographic union. Arthroscopic iliac crest bone grafting to the anterior. Anterior iliac crest bone graft atlas of operative oral and. Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Stability of simultaneously placed dental implants with. A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice.
Operation technique both groups underwent the same procedure of the harvest. Harvesting autogenous cancellous bone graft from the anterior. Pdf reconstruction of anterior iliac crest bone graft. Three techniques are recommended for surgical correction of scaphoid nonunion with bone graft and internal fixation with a screw. According to the literature, the fracture of the iliac crest after bone harvesting should not be considered a frequent complication. Modified sauvekapandji procedure using iliac bone graft. Belthur mv, conway jd, jindal g, ranade a, herzenberg je. Iliac crest pain is associated with chronic low back pain. With the rise of mirovascular surgery, the iliac crest well known as a non vascularized bonegraft obviously was one of the first candidates to be converted into a free vascularised bone graft. For instance, orthopedists and neurosurgeons prefer the posterior part of the iliac crest, while oral maxillofacial surgeons usually take bone from the anterior region. Pdf anterior iliac crest bone graft harvesting researchgate. Acute and chronic complications of intracortical iliac crest. 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.
Optimal site for bone graft harvesting from the iliac bone epos. We describe a technique and case report of iliac crest autograft harvest using a. Different areas of the iliac crest are used to obtain dissimilar types of bone grafts in relationship to the surgery required. Screw tentpole grafting technique for reconstruction of. Autogenous bone grafting is often done in orthopaedic surgery for a variety of conditions. Autologous cells harvested from the iliac crest bone marrow can be used as other alternative therapies 7 without the complications compared to standard bone grafts. These bone grafts are called autografts and are used primarily to replace bone lost to injury or illness.
The borders of the posterior ilium are the iliac crest superiorly, the posterior superior iliac spine psis posteriorly, and the greater sciatic notch inferiorly. There have been only six reported cases in the literature, with more than 100,000 bone grafting procedures performed each year. The gold standard is autologous bone graft obtained from the iliac crest icbg4,5 pros. Surgical techniques scaphoid nonunion orthobullets. Using an iliac crest bone graft as ulnar support in reconstruction surgery could be a practical method after the ulnar head has been resected. Bone can be harvested from nonessential bones, such as from the iliac crest, or more commonly in oral and maxillofacial surgery, from the mandibular symphysis chin area or anterior mandibular ramus the coronoid process. A retrospective study of iliac crest bone grafting. However, the comparative longterm stability of these two autologous bone grafts have not yet been investigated. A 10year followup of transpedicular screw fixation and. The patient is positioned supine with the surgical extremity on a radiolucent arm table. We prefer to isolate inner table only and leave the outer table, however, there are times when full thickness iliac crest is required.
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