Bone Graft Harvesting Research Articles

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects.

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.

Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty.

Background: COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Methods: Airborne particulate generation in the 1-10 μm range was quantified with an optical particle sizer in real time during cadaveric-simulated rhinoplasty and facial trauma conditions. Procedures tested included mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use. Particulate generation was measured both adjacent to the surgical site and at surgeon mouth level (SML). Results: Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML (p < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site (p < 0.01). Standard nasal osteotomies and dorsal rasping did not generate detectable airborne particulate, whereas piezoelectric saw use was associated with significant particulate generation both adjacent to the surgical site (p < 0.001) and at SML (p < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. Conclusions: The majority of craniomaxillofacial trauma procedures involve particle generation that may be limited in spread by the use of local irrigation. Most bony work involved in rhinoplasty can be safely performed without a high degree of particle formation. The use of piezoelectric instruments in rhinoplasty should be avoided when concerned for particulate generation.

Examining the Safety and Efficacy of Supplemental Regional Anesthesia After Iliac Crest Harvest During Cleft Alveolar Bone Grafting

Background: The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of minimal access bone graft techniques with or without regional anesthesia in iliac crest bone harvest and compare to outcomes to traditional open harvest techniques. Methods: A retrospective review of 46 patients undergoing iliac crest bone harvest using traditional open iliac crest bone graft (ICBG) alone (Group 1, n = 20), minimal access ICBG (Group 2, n = 20), or minimal access ICBG with paravertebral anesthetic block (Group 3, n = 5) was performed. Post operative pain scores, narcotic consumption, and hospital stay were analyzed. Results: The average time to first narcotic was 247 minutes in Group 1, 193 in Group 2, and 1162 minutes in Group 3 ( P &lt; .0002). Total narcotic use was 0.117 mg/kg in Group 1, 0.131 mg/kg in Group 2, and 0.072 mg/kg in Group 3. The average pain score (VAS) was 2.96 in Group 1, 1.83 in Group 2, and 1.08 in Group 3 ( P &lt; .01). The average length of stay was 1.45 for Group 1, 1.36 for Group 2, and 1.0 for Group 3. Bone graft extrusion occurred in 6 patients (27.3%) in Group 1 and none in Group 2 or 3. There were no wound infections, bleeding requiring reoperation, or mortalities. Conclusion: The addition of regional anesthesia to minimal access alveolar bone graft harvest significantly reduces time to first narcotic use. Although not significant, a strong trend was found with regional anesthesia to lower the pain score (VAS) and total narcotic use. Regional anesthesia did not significantly reduce the length of hospital stay compared to either group. Minimal access techniques with supplemental regional anesthesia significantly lowered the pain score and time to first narcotic and trended to decreased length of hospitalization and total narcotic use compared to traditional open techniques.

Presentation and short-term evaluation of an all-in-one patient-specific implant for cranial reconstruction: A randomized controlled trial

Cranial reconstruction after bone graft harvesting remains a challenge. A patient-specific implant (PSI) to guide harvesting and reconstruction was evaluated and compared with the use of a free-hand procedure with calcium phosphate cement (C). Patients were randomized to either the PSI or C group. The outcome was measured clinically and radiographically as the primary endpoint. Secondary endpoints were ease of application, patient and surgeon satisfaction, and the complication rate. Twenty patients were randomized to the PSI (n=10) and C (n=10) groups. Two PSI patients were switched to the cement group due to a poor fit of the PSI. There was a non-significant trend towards more successful outcomes in the PSI group. Two PSI patients presented palpable screws, and one cement patient had a palpable dimple. Cone beam computed tomography showed a significantly lower median volume discrepancy in the PSI group (P<0.0001). The total surgical manipulation time was significantly higher in the PSI group. At 10 days postoperative, three PSI and two C patients presented with minor postoperative complications. There was no significant difference in patient or surgeon satisfaction. PSIs are a reliable alternative to cement. This PSI is novel as it also serves as a guide for harvesting the bone blocks required for reconstructive purposes.

Clinical experience of the use of reamer irrigator aspirator in Japanese patients: A report of the first 42 cases

BackgroundA reamer irrigator aspirator (RIA) can be used to harvest substantial amounts of autologous bone and debride the intramedullary canal. Clinical experience using reamer irrigator aspirators in Japan is very limited. The applicability of the reamer irrigator aspirator head with a minimum diameter of 12 mm for Japanese people is often questioned as the Japanese are smaller than Americans and Europeans. There are no reports of complications in Japanese patients. This study aimed to retrospectively review clinical cases and describe reamer irrigator aspirator use in Japanese patients. MethodsAll patients for whom a reamer irrigator aspirator was used during surgery at our hospital between January 2014 and September 2018 were included. The patients’ clinical and radiographic data were retrospectively reviewed. ResultsData of 40 patients (42 cases) were collected. The reamer irrigator aspirator was used for bone graft harvesting in 32 cases, intramedullary debridement and irrigation in 9 cases, and reaming for exchange nailing in 1 case. The diameter of the reamer irrigator aspirator reamer head was 12 mm in 22 cases (53.7%), 12.5 mm in 4 cases (9.8%), 13 mm in 9 cases (22.0%), 13.5 mm in 1 case (2.4%), 14.0 mm in 1 case (2.4%), 14.5 mm in 1 case (2.4%), and 15 mm in 4 cases (9.8%). Mean intraoperative bleeding volume was 1158.6 mL (range, 100–3800 mL). We experienced no difficulty inserting the reamer irrigator aspirator into the intramedullary canals and no cases of insertion-related intraoperative fracture. Five cortical perforations (11.9%) were observed on postoperative computed tomography scans, although no patient was symptomatic. One case (2.4%) of postoperative femur fracture occurred. ConclusionsReamer irrigator aspirators can be used in Japanese patients. Smaller reamer head sizes were mainly used in our experience. We should manage complications as in previous reports from Western countries.

Superior Cluneal Neuralgia from Iliocostal Impingement Treated with Phenol Neurolysis: A Case Report

Background: Superior cluneal neuralgia (SCN) is an increasingly recognized yet still frequently overlooked cause of chronic lumbosacral and buttock pain. While historically attributed generally to iatrogenic iliac crest injury (bone marrow biopsy or bone graft harvest), more recently it is recognized as occurring in the absence of any trauma, with idiopathic entrapment resulting in compression neuropathy. Iliocostal impingement syndrome (IIS) is an even less commonly considered condition whereby the lower costal margin repetitively contacts and irritates the iliac crest, primarily occurring unilaterally and owing to severe scoliosis, but also in the context of severe vertebral column height loss. Case Report: We report here a case of an elderly woman with a 3-inch reported height loss over the decades who had suffered with chronic and intractable right lumbosacral and gluteal pain, and whom, on the basis of physical examination, we diagnosed presumptively with both SCN and with IIS as the underlying pathophysiologic mechanism. After undergoing successful diagnostic fluoroscopically guided superior cluneal nerve block, she was offered phenol denervation and enjoyed 9 months of reported 90% improvement in her symptoms, with gradual return to baseline over the next couple months. She has subsequently undergone repeat phenol denervation twice, with similarly good results. We believe this to be the first documented application of phenol neurolytic technique to SCN, and in the case of iliocostal impingement we argue that surgical release/resection or even peripheral nerve stimulation may not be effective owing to underlying compression/irritation diathesis from the inevitable pressure of the costal margin upon the iliac crest. Conclusion: In this case report, we also briefly summarize the current literature on SCN and compare phenol neurolysis to other therapeutic modalities. Key words: Superior cluneal nerves, neuralgia, iliocostal impingement, phenol, denervation

STAND-ALONE PEEK CAGE FOR SINGLE LEVEL CERVICAL DISC DISEASE SHORT TERM RESULTS.

The Enthusiasm for Cervical cages in cervical fusion operations is an effort to avoid the morbidity associated with autogenous bone graft harvesting. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with hydroxyapatite granules in the treatment of single level disc affection. 19 patients affected by single-level cervical disc disease were included in this study. The clinical findings were assessed according to Odom’s criteria at last follow-up. Cervical spine segmental sagittal alignment was evaluated preoperative, direct postoperative and 12 months later. 19 patients underwent ACDF using a PEEK cervical cage. The clinical assessment according to Odom’s criteria after 12 months was excellent in 50%, good in 24% patients, fair in 11% and 15 poor clinical results. The mean segmental lordosis before surgery was 2°, corrected to - 6.6° immediately postoperative. The final mean segmental lordosis was 3.3°; the loss of correction was 3.5°. Anterior cervical discectomy and fusion using a stand-alone PEEK cage can be considered a safe and effective technique for the management of single level cervical disc disease.

Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome.

Background: The aim of this study was to evaluate the complications following calcaneal autologous bone graft harvesting using an osteotome in patients who underwent foot and ankle surgery with follow-up of at least 1 year. Methods: In a cohort study, all consecutive patients underwent forefoot or midfoot surgeries in conjunction with harvesting bone graft from the calcaneus using lateral wall corticotomy technique by an osteotome from 2015 till 2018 were asked to follow. The outcome and morbidity were assessed by visual analogue scale (VAS) pain, numbness in territory of the sural nerve, surgical site numbness or tenderness, infection, hematoma formation, or pathologic fracture. Also any possible restrictions on wearing desired shoes were asked. Results: Totally, 50 patients (11 males, 39 females; 29 right foot, 21 left foot) with the mean age of 48.2 ± 13.8 years (range 8-66 years) were assessed. There were no major complications on donor site such as infection, hematoma formation, or pathologic fracture. The following results were seen; 90% without any pain (VAS 0/10), 96% without numbness at the incision site, 96% without point tenderness on lateral of heel, 98% without paresthesia or numbness in the sural nerve territory, and 84% were able to wear their favorite shoes. Forty-one (82%) cases said if they need another foot surgery, they would permit to harvest bone graft from their heel. Conclusions: Autologous bone graft harvesting from the calcaneus using lateral wall corticotomy technique by an osteotome could be a useful method with very low complications.Levels of Evidence: Therapeutic, level IV: cohort, case series.

Quantum of cortico-cancellous bone safe for harvest from anterior iliac wing of pediatric patients: a finite element analysis with clinical correlation

Background: Objective was to assess the maximum quantum of cortico- cancellous bone that can be harvested from the Anterior Iliac Wing (AIW) of paediatric population.Methods: All patients reporting to the unit for the correction of bilateral cleft alveolus were included. A Computed Tomogram (CT) of the hip was recorded and the volume of cancellous bone available for harvest was assessed. Finite element model of the hip was generated using D2P and Geomagic Free form software and the impact of bone harvest on stress distribution along the anterior iliac wing was assessed by substituting the muscle forces (hip abductors and sartorius group) and was clinically correlated to volume harvested and donor site morbidities.Results: 10 patients were enrolled, 5 patients were excluded. CT volumetric evaluation revealed an average 0.5 cc to 4.7 ccof cancellous bone and 6.7 cc to 11 cc of cortical bone was available for harvest. Harvest of 50% of available graft volume was safe with minimal stress distributed along the line joining the tuberosity to the area between Antero Superior and Inferior spines (4.2 MPa at rest and 18.5 MPa at stance). The stress levels increased with increase in volume of bone harvested. Intra operatively 1.9 cc to 6.2 cc of cortico cancellous graft was harvested, which was equivalent to 60% of the graft available with no long-term morbidities.Conclusions: The volume of bone graft harvest should be restricted (up to 6 cc) to avoid long term morbidities.

Surgical Treatment of Solitary Enchondromas of the Hand.

Objective: The present retrospective study evaluated the clinical and radiologic results of patients who underwent complete curettage and autologous bone grafting for hand-located isolated enchondromas with a minimum follow-up period of one year.Patients and Methods: Thirty-two patients with a follow-up period of at least 12 months who underwent operation between August 2010 and October 2018 due to the presence of solitary enchondroma of the hand were included in the study. All patients underwent complete curettage and filling of the defect via autologous bone grafting. Autologous bone graft was harvested from the iliac crest and distal radius in 24 and eight patients, respectively. The patients underwent radiography on the first postoperative visit and at six weeks, 12 weeks, and annually. The range of movement of the finger joint was evaluated by comparing it with the healthy contralateral side. Functional outcomes and radiologic outcomes were evaluated. The frequency of complications and recurrences were established.Results: Twelve patients were male and 20 were female. The average age was 34 (range: 16-56) years. The most common digit involved was the little finger (nine cases, 28.125%); the proximal phalanx was the most common location (17 cases, 53.125%). Control radiography in the sixth week revealed graft consolidation in all patients. No case of nonunion or recurrence was detected clinically or radiologically, with a mean follow-up period of 54 (range: 12-96) months. Functional outcomes were classified as excellent in 28 patients and as good in four patients. The final radiographic appearances included Tordai’s group 1 in 28 bones and group 2 in four bones. Conclusion: Curettage and autologous bone grafting are safe, costless, and effective treatment options for hand enchondroma, with satisfactory functional and radiographic outcomes. Harvesting bone graft from the distal radius provides a shorter length of hospital stay and lower complication rates compared to obtaining the graft from the iliac crest.

Miniinvazivní odběr spongiózních štěpů v traumatologické indikaci - klinická část studie

Miniinvazivní odběr spongiózních štěpů v traumatologické indikaci - klinická část studie

MORBIDITY ASSOCIATED WITH HARVESTING OF ILIAC CREST BONE GRAFT FOR MAXILLOFACIAL RECONSTRUCTION

Objective: To evaluatethe post-operative morbidity associated with harvesting of iliac crest bone graft. Materials and Methods: This study was conducted in the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore, from March 2010 to March2012; and at the Department of Oral &amp; Maxillofacial Surgery, Fatima Memorial Hospital Lahore, from June 2012 to June 2017. After approval of the study was obtained from Institutional Review Board (IRB), informed consent of the patients was taken on customized proforma.A total of 36 patients were subjected to reconstruction of maxillofacial bony defects with 36 bone grafts harvested from anterior iliac crest; 20(55.56%) were male and 16 (44.44%) were female patients with mean age of 23 ± 10.31years (range 11-52 years). Results: At 3 months postoperatively, the pain score was noted as: 02 patients (5.5%) had score 1 and 34 patients (94.44%) had score 0. Only one patient (2.77%) had abnormality in gait. The donor site scars were assessed according to the patients’ satisfactory score whereby 24 patients (66.66%) had a score of 2; 04 patients (11.11%) had score 3 and 08 patients (22.22%) had score 1. While scar hypertrophy was seen in 2 patients (11.11%), wound dehiscence was seen in 1 patient (5.55%) only. Conclusion: Harvesting of bone graft from the anterior iliac crest is a safe and predictable surgical procedure for reconstruction of defects of oral and maxillofacial region with high patient tolerance, low morbidity and fewer complications.

Miniplate-Augmented Interlaminar Fusion in C1–C2 Screwing

The interlaminar fusion combination involving C1-C2 screwing fixation is one of the most effective techniques for atlantoaxial dislocation or subluxation, and the bone graft is usually stabilized by wiring constructs. However, some adverse events were reported during the insertion of sublaminar wiring, such as accidentally damaging the spinal cord or dura. Thus we used the miniplate to stabilize the harvest bone graft on the C1-C2 laminar, which led to a shorter operation time and prevented spinal canal violation. This study investigated the safety and efficacy of the novel surgical technique, namely miniplate-augmented interlaminar fusion. We retrospectively reviewed 43 patients who underwent posterior atlantoaxial fusion with the miniplate-augmented iliac crest autograft at our institute. Complications related to surgery were recorded and calculated. After operation, patients were followed up through routine radiography to examine whether the fusion of the atlantoaxial segment was achieved. Success of fusion was defined as follows: 1) the presence of bone bridging between the bone graft and both the atlas and axis; and 2) the absence of movement of the atlantoaxial spinous process on flexion-extension radiography, which meant that the variation of length measured in 2 views, respectively, was <1 mm. The first time when radiography showed successful fusion after surgery was termed as fusion time and was recorded individually. In addition, overall fusion rates and mean fusion times were analyzed. Of 43 patients, long-term follow-up data were available for 31 patients, whereas the remaining 12 patients had dropped out (mean follow-up duration, 24.91 months; range, 6-72 months). Among 31 patients, 22 (70.96%) were women and 9 (29.03%) were men. The mean age was 63.33 years. Regarding the etiology, atlantoaxial dislocations or subluxations were caused due to degeneration, rheumatoid arthritis, odontoid fracture, trauma, and os odontoideum in 14 (45%), 3 (10%), 5 (16%), 8 (26%), and 1 (3%) patient(s), respectively. Successful fusion was achieved in 30 (96.77%) patients, with a mean fusion time of 6.23 months, whereas only 1 (3.23%) patient did not meet the fusion criteria. No complications related to the miniplate occurred. We noted vertebral artery rupture not requiring blood transfusion in 1 patient, aspiration pneumonia in 1 patient, urinary tract infection in 1 patient, anemia requiring transfusion in 1 patient, and leg dysesthesia in 1 patient. No neurologic deficit was found. Miniplate-augmented interlaminar fusion with C1-C2 screwing resulted in excellent fusion rates with a considerably low probability of complications. Hence this novel technique for bone graft fixation with atlantoaxial screwing has a good efficacy and safety and can serve as an alternative for bone graft fixation during C1-C2 fusion.

The Effect of Single-Dose Bupivacaine on Postoperative Iliac Crest Graft Donor Site Pain.

Background:Postoperative donor site pain remains a major source of morbidity following iliac crest bone graft harvesting (ICBGH).Aim:The aim of this study was to investigate the effect of single-dose infiltration of bupivacaine on donor site pain following ICBGH.Subjects and Methods:This study was a double-blind randomized controlled trial of 30 adult individuals that required an ICBG as part of the treatment for mandibular reconstruction. Individuals were divided into two groups, to receive a single-dose subcutaneous infiltration of either 0.25% bupivacaine or 0.9% normal saline at the iliac crest graft incision site following ICBGH. Length of incision at the ICBGH site, dimensions of harvested graft, time taken for the iliac crest harvest surgery, total daily dose of postoperative analgesics, pain from the ICBGH site as well as gait disturbance were recorded. Data were analyzed using SPSS version 17.0, and P < 0.05 was considered statistically significant.Results:There was a progressive decrease in pain score from the 1st to the 4th postoperative day, with no significant difference between the two groups. There was no statistical difference between the two groups in terms of dynamic median pain score at the early postoperative period as well as at the 4th and 12th week postoperative period. The analgesic consumption between the two groups also did not show any significant difference.Conclusion:Local injection of single dose of 0.25% bupivacaine did not offer additional benefit in the management of postoperative iliac crest donor site pain following ICBGH.

Ultrasound-guided transmuscular quadratus lumborum block for anterior iliac crest bone graft promotes early ambulation in patients undergoing cervical corpectomy and fusion

Context: The iliac crest (IC) is widely used as an autograft for bony fusion in spine surgeries. The pain after IC harvesting is severe enough to delay ambulation and thus hospital discharge. Aim: This study aimed to determine the effect of a transmuscular quadratus lumborum block (QLB) on postoperative ambulation in patients undergoing anterior IC bone graft harvesting. Settings and Design: This was a retrospective study of patients who underwent cervical corpectomy and fusion with anterior IC bone graft over a period of 3 years. Materials and Methods: Group A was patients who received QLB for anterior IC bone graft harvest site pain, and those who did not receive QLB were Group B. The primary outcome was the time taken for ambulation, and the secondary outcomes compared were the pain scores, hemodynamics, and the duration of hospital stay. Results: A total of 34 patients were studied, of which 17 patients received QLB (Group A) and the rest 17 did not receive QLB (Group B). The demographics, preoperative and intraoperative variables, and the pain score were comparable between the groups. The patients in the QLB group ambulated early as compared to Group B (1.5 ± 0.7 vs. 2.4 ± 0.9 days = 0.002). Further, the duration of postoperative hospitalization was shorter in the former as compared to the latter (3.8 ± 1.6 vs. 5.1 ± 2.1 days; P = 0.054). There were no complications related to the QLB. Conclusion: The administration of QLB resulted in earlier postoperative ambulation in patients undergoing cervical corpectomy with AIC bone graft. Although the length of hospitalization was shorter in the QLB group, it was not statistically significant.

Three-dimensional evaluation of the mandibular symphyseal region in block graft harvesting for dental implants using cone-beam computed tomography.

PurposeThe purpose of this study was to analyze the quantity and quality of the mandibular anterior alveolar bone in terms of alveolar width, density, and total alveolar height (TAH) based on dental status, gender, and age. Additionally, this study aimed to quantitatively evaluate the available alveolar height for graft harvesting (AHGH) and examine its variability based on the aforementioned factors.Materials and MethodsThis retrospective cone-beam computed tomographic study included a total of 100 subjects. On the basis of gender, dental status, and age, the scans were divided into 3 primary groups and 8 subgroups. The mandibular alveolar width and density were measured 5 mm mesial to the mental foramen bilaterally and at the midline. The TAH was measured at the midline, and the AHGH was measured as the midline distance between 5 mm apical to the root of the canines and 5 mm superior to the lower border.ResultsThe mandibular alveolar width was statistically similar between dentulous and edentulous patients (P>0.05). A significantly greater density was observed at the midline in edentulous patients (P<0.05). The TAH was significantly greater in edentulous male patients than in edentulous female patients (P<0.05). Dentulous and male patients had significantly greater AHGH than edentulous and female patients, respectively (P<0.05).ConclusionBased on the data evaluated in this study, it can be concluded that the mandibular symphyseal area has adequate bone quality and quantity for bone graft harvesting for dental implant therapy.

Analysis of donor site complications at the anterior iliac crest harvest site for treatment of tibial plateau fractures

Introduction: In tibial plateau fractures with intraarticular depression and metaphyseal comminution, bone grafting or the use of a bone substitute may be required. Harvesting autologous iliac crest bone graft for other orthopedic procedures has complications. The aim of this study was to evaluate the complication rate after harvesting bone graft as used for the treatment of tibial plateau fractures. Patients and methods: Patients treated in a tertiary care hospital with operative intervention for tibial plateau fractures with iliac crest bone graft between January 2015 and December 2018 were included in this retrospective study. Patients’ records were evaluated and clinical evaluation was performed at follow-up. Results: 46 patients (20 females, 26 males, mean age 55.2±14.9 years) were included in this study. Follow-up was mean 4.3±1.2 years. Only minor complications such as hematoma could be identified; in one patient, repeat surgery for bleeding was performed. No nerve injuries, long-term pain, fractures, infections or wound healing disturbances could be seen. The use of a drain, the type of wound closure or amount of harvested bone did not influence complication rate. Conclusion: This study shows that harvesting of iliac crest bone graft for the treatment of tibial plateau fractures is a safe procedure with a very low complication rate. Keywords: Tibial plateau fractures Iliac crest bone graft Donor site complications

Arthroscopic Harvesting of Autologous Bone Graft for Use as a Mesenchymal Stem Cell Carrier in Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) tears are detrimental to knee stability and normal function. Although the standard of treatment is an ACL reconstruction, technical improvements are sought to enhance clinical outcomes due to the appreciable failure rate. The use of autologous biologic substances as carriers of stem cells are desirable because of their multipotent properties. Traditionally, the collection of autologous bone grafts is through an open incision of the iliac crest, which causes substantial morbidity to the patient. This Technical Note describes an arthroscopic, minimally invasive collection method of autologous tibial and femoral bone graft to use in backfilling the tunnels during an ACL reconstruction to improve graft incorporation and clinical outcomes.

Patient Perceptions of Iliac Crest Bone Grafting in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Retrospective cohort. The objective of this study was to determine patients' perception of iliac crest bone graft (ICBG) harvesting and donor site pain following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The incidence of donor site pain has been debated in the literature because of the varying techniques associated with its harvest. Patients undergoing primary, single-level MIS TLIF with ICBG were retrospectively identified. ICBG harvesting was performed using a percutaneous technique with a tubular retractor. A survey was administered to assess if patients could accurately describe which side of their iliac crest they believed was harvested, and if they were experiencing any pain perceived to be originating from the donor site. Patient characteristics were compared using χ analysis and independent t test. In total, 82 patients were included. The majority of patients had the ICBG harvested from the left iliac crest (97.5%). Approximately half of the patients correctly identified the side of harvest (50.6%). 48.1% of patients reported they were not confident or had guessed on their response. Patients that reported pain from the ICBG were more likely to feel confident or somewhat confident in their harvest site identification (57.9% vs. 46.3%) but less likely to be correct (36.8% vs. 63.4%) than patients without pain. 22 patients (27.8%) correctly identified the side of harvest without guessing. Of these, 11 (13.9%) reported pain. Approximately half of patients undergoing MIS TLIF with ICBG are able to correctly identify which side of their iliac crest was harvested. However, the majority of patients reporting pain were unable to correctly identify the side of harvest. This suggests that most patients are likely attributing other sources of pain to their ICBG. Therefore, rates of donor site pain may be over-reported in the current literature with contemporary harvesting techniques.

Donor Site Changes in Bone Thickness, Volume, and Density Following Split Cranial Bone Graft Harvest.

The calvarium can provide large amount of good quality corticocancellous autogenous bone graft. Although many studies have highlighted the advantages of the split cranial bone graft, there is no published work available in the literature about the fate of donor site of the split cranial bone graft. The present study was undertaken to assess the donor site as regards to the thickness, volume, and the density of the residual bone over a period of 12 months in the postoperative period. A total of 30 patients in the age group of 15 to 43 years were studied from January 2015 to January 2016. Postoperative computer tomography scans were taken at 2 weeks, 6 months, and 1 year postoperative to measure the bone thickness, volume, and density at the donor site of the split cranial bone graft harvest. The bone thickness at the donor site showed progressive increase in the thickness over the period of study and the average increase in thickness was about 12.4% at the end of 1 year. The average increase in volume at the donor site was of 2.65% after 12 months. Similarly, the average bone density increased by 3.7% at the end of 1 year. This prospective study conclusively proves that the residual bone at the donor site of the split cranial bone graft harvest site continues to grow in thickness and density over a period of 1 year.