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

2017 ◽  
Vol 54 (6) ◽  
pp. 674-679 ◽  
Author(s):  
John T. Stranix ◽  
Daniel Cuzzone ◽  
Catherine Ly ◽  
Nicole Topilow ◽  
Christopher M. Runyan ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cortical Thickness ◽  
Cancellous Bone ◽  
Reference Point ◽  
Iliac Crest ◽  
Bowel Perforation ◽  
Iliac Bone ◽  
Iliac Crest Bone Graft ◽  
Visceral Injury ◽  
Graft Harvest

Objective To determine the potential risk of visceral injury during Acumed drill iliac crest cancellous bone graft harvest. Design Radiographic iliac crest anatomic analysis with simulated drill course to measure cancellous bone available for harvest and proximity of vulnerable pelvic structures. Setting Single institution, tertiary care university hospital. Patients and Participants One hundred pelvic computed tomography scans performed on children 8 to 12 years old without traumatic or neoplastic pathology. Interventions Radiographic simulation of Acumed drill course within iliac bone. Main Outcome Measures (1) Potential for pelvic visceral injury. (2) Volume of cancellous bone safely available for harvest. Results Superior and medial cortical thickness at the reference point remained stable across age groups; however, lateral cortical thickness increased with age (3.13 to 3.74 mm, P < .001). Cancellous bone width increased with age at all depths measured ( P < .001). Through radiographic simulation, the drill could reach the bowel in 4% of cases and only through gross deviation (>30°) from the plane of the ilium. There were no cases of simulated bowel perforation within 3 cm of the reference point. The maximum cancellous volume safely harvested increased with age: 24 cc in 8-year-olds to 36 cc in 12-year-olds ( P < .001). Conclusions 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.

Harvesting Iliac Bone Graft: Decreasing the Morbidity

1999 ◽  
Vol 36 (5) ◽  
pp. 388-390 ◽  
Author(s):  
Jorge I. de la Torre ◽  
Mayer Tenenhaus ◽  
Pamela M. Gallagher ◽  
Stephen A. Sachs
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Iliac Crest ◽  
Skin Incision ◽  
Iliac Bone ◽  
Pain Disability ◽  
Graft Harvest ◽  
Iliac Bone Graft ◽  
Classic Technique ◽  
Abundant Supply

Objective: This is a review of modifications made to the classic technique for harvesting bone graft from the iliac crest. Prior techniques for harvesting iliac bone often resulted in significant postoperative pain, disability, and a cosmetically unacceptable scar and contour deformity. Design: A retrospective review of patients who underwent bone graft harvest over a 7-year period was done. Interventions: The modifications described use a skin incision medial to the anterior superior iliac crest. The medial aspect of the iliac crest is elevated along the midsagital axis of the crest. The medial cap is reflected outward, exposing cancellous bone. Results: A review of 51 patients demonstrated only two minor self-limiting complications. Conclusions: This procedure provides an abundant supply of both cortical and cancellous bone, an aesthetically acceptable scar, and decreased patient discomfort.

Results of an Alternative Autogenous Iliac Crest Bone Graft Harvest Method

Orthopedics ◽  
2006 ◽  
Vol 29 (4) ◽  
pp. 342-346 ◽  
Author(s):  
Stephen C. Brawley ◽  
R. Bruce Simpson
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Iliac Crest Bone Graft ◽  
Graft Harvest ◽  
Harvest Method

A Comparison of Shepard's Osteotome versus Trapdoor Flap Technique to Harvest Iliac Crest Bone for Secondary Alveolar Bone Grafting

2008 ◽  
Vol 45 (4) ◽  
pp. 347-352 ◽  
Author(s):  
J. Constantinides ◽  
P. Chhabra ◽  
P. J. Turner ◽  
B. Richard
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Iliac Crest Bone Graft ◽  
Open Technique ◽  
Flap Technique ◽  
Graft Harvest ◽  
Alveolar Bone Grafting

Objective: To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique. Design: A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies. Patients: A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique. Results: Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques. Conclusion: The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.

Trephine Technique for Iliac Crest Bone Graft Harvest

Spine ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Robert F. McLain ◽  
Fernando Techy
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Iliac Crest Bone Graft ◽  
Graft Harvest

Local Bone Graft Harvested From the Distal Tibia or Calcaneus for Surgery of the Foot and Ankle

2005 ◽  
Vol 26 (6) ◽  
pp. 449-453 ◽  
Author(s):  
Steven M. Raikin ◽  
Kenneth Brislin
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Distal Tibia ◽  
Autologous Bone Graft ◽  
Operative Procedures ◽  
Iliac Crest Bone Graft ◽  
Foot And Ankle ◽  
Graft Harvest ◽  
Local Bone ◽  
Autologous Bone

Background: Numerous operative procedures around the foot and ankle use bone graft to augment healing. Autologous bone graft remains the preferred type for these procedures. This can be harvested from the iliac crest, but complications are frequent. The purpose of our study was to investigate the option of harvesting the bone graft from the ipsilateral distal tibia or calcaneus. Method: Bone graft was harvested in 114 patients from the distal tibia (70 patients) or calcaneus (44 patients). The patients were followed postoperatively for an average of 16 (range 5 to 28) months and were evaluated for complications (minor and major), satisfaction, and healing rates. Results: There were no major complications. Ten patients (8.7%) had minor complications including initial incisional sensitivity or local numbness, none of which affected function or required additional treatment. Satisfaction rate for the procedure was 100%. Conclusion: Use of autologous bone graft harvested from the ipsilateral distal tibia or calcaneus is a safe and reliable alternative to iliac crest bone graft harvest for operative procedures of the foot and ankle.

Quantitative Analysis of Cancellous Bone Graft Available from the Greater Trochanter

1996 ◽  
Vol 17 (8) ◽  
pp. 473-476 ◽  
Author(s):  
Eric J. Lindberg ◽  
Stuart D. Katchis ◽  
Ronald W. Smith
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Proximal Femur ◽  
Iliac Crest ◽  
Secondary Source ◽  
Cancellous Bone Graft ◽  
Greater Trochanter ◽  
Graft Harvest ◽  
Digital Compression ◽  
Trochanteric Region

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 × 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.

Bupivacaine for Pain Reduction After Iliac Crest Bone Graft Harvest

Orthopedics ◽  
2014 ◽  
Vol 37 (5) ◽  
pp. e428-e434 ◽  
Author(s):  
Kevin R. O’Neill ◽  
Dennis T. Lockney ◽  
Jesse E. Bible ◽  
Colin G. Crosby ◽  
Clinton J. Devin
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Pain Reduction ◽  
Iliac Crest Bone Graft ◽  
Graft Harvest
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