Abstract
BackgroundIliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects. The objective of this study is to assess the biomechanical quantities related to risk for pelvic fracture after harvesting an autologous bone graft at the anterior iliac crest.MethodsFinite element models with a simulated harvest site (sized 15 × 20 mm, 15 × 35 mm, 30 × 20 mm and 30 × 35 mm) in the iliac wing are created. The relevant loading case is when the ipsilateral leg is lifted off the ground. Musculoskeletal analysis is utilized to compute the muscle and joint forces involved in this motion. These forces are used as boundary conditions for the finite element analyses. Bone tissue stress is analyzed.ResultsCritical stress peaks are located between the anterior superior iliac spine (ASIS) and the anterior edge of the harvest site. Irrespective of the graft size, the iliac wing does not show any significant stress peaks with the harvest site being 20 to 25 mm posterior to the ASIS. The harvest area itself inhibits the distribution of the forces applied on the ASIS to extend to the posterior iliac wing. This leads to a lack of stress posterior to the harvest site. A balanced stress distribution with no stress peaks appears when the bone graft is taken below the iliac crest.ConclusionA harvest site located at least 20 to 25 mm posterior to the ASIS should be preferred to minimize the risk of iliac fatigue fracture.
Highlights
Iliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects
Due to the nature of the study based on a computer tomography (CT) scan that was performed for another reason than the finite element analysis (FEA) without need for any further individual data, the “Independent Ethics Committee of the Faculty of Medicine” at the University Regensburg Medical Centre confirmed that an ethics opinion in accordance with the 1964 Helsinki Declaration is not necessary
Since this study focuses on the relative stress distribution on the iliac wing rather than the absolute stress values, the bone age of the used CT scan is not of significant relevance
Summary
Iliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects. The objective of this study is to assess the biomechanical quantities related to risk for pelvic fracture after harvesting an autologous bone graft at the anterior iliac crest. Iliac crest bone harvesting is a frequently performed surgical procedure that is widely used to treat bone defects in orthopedic and trauma surgery as well as in reconstructive surgery and oral and maxillofacial surgery. The objective of this investigation is to assess the risk for fatigue iliac crest fracture following cortico-cancellous bone harvesting at the anterior iliac wing.
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