Prospective Observational Study of Donor-Site Morbidity Following Anterior Iliac Crest Bone-Grafting in Orthopaedic Trauma Reconstruction Patients

• Published in: Journal of bone and joint surgery. American volume 2012-09, Vol.94 (18), p.1649-1654
• Main Authors: Loeffler, Bryan J, Kellam, James F, Sims, Stephen H, Bosse, Michael J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis of Variance; Biological and medical sciences; Bone Transplantation - adverse effects; Bone Transplantation - methods; Case-Control Studies; Confidence Intervals; Diseases of the osteoarticular system; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures, Bone - diagnostic imaging; Fractures, Bone - surgery; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Humans; Ilium - surgery; Ilium - transplantation; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Orthopedic surgery; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - physiopathology; Prospective Studies; Radiography; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Transplant Donor Site - physiopathology; Transplantation, Autologous; Traumas. Diseases due to physical agents; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.K.00961

BACKGROUND:Complications associated with iliac crest bone-graft donor sites have been reported. This prospective study was conducted to determine the prevalence of pain and complications at the iliac crest donor site in patients undergoing treatment of fracture nonunion. METHODS:Ninety-two patients undergoing anterior iliac crest bone-grafting for nonunion or delayed union of a long-bone fracture were prospectively enrolled. Twenty-seven patients undergoing an alternative surgical treatment were enrolled as a control group. Questionnaires including pain on a visual analog scale (0 to 10) at the donor site were completed by patients at two weeks, six weeks, three months, and one year postoperatively. Short Form-36 (SF-36) forms were completed at enrollment and at the time of final follow-up. RESULTS:The mean pain on the visual analog scale at the donor site was 3.9 at two weeks but rapidly decreased to 1.4 at six weeks and reached 0.3 at one year or more postoperatively (p < 0.001). Only two patients (2%) reported a pain value of >3 at one year or more postoperatively. There were three deep infections (3%) at the donor site, and no patients had a permanent sensory deficit in the lateral femoral cutaneous nerve distribution. At the time of final follow-up (mean, twenty-two months), scores for the SF-36 bodily pain subscale were significantly higher in the iliac crest group than in the control group, indicating a greater improvement in overall bodily pain in the iliac crest group. CONCLUSIONS:Anterior iliac crest bone-grafting for nonunion was a well-tolerated procedure. Substantial, persistent pain at the iliac crest donor site occurred in 2% of patients. Iliac crest bone-grafting did not appear to impair function or well-being compared with alternative treatments. LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.