: Previous studies have demonstrated high complication rates after
harvest of iliac crest bone grafts. This study was undertaken to
compare the morbidity related to the harvest of anterior iliac crest
bone graft with that related to the harvest of posterior iliac crest
bone graft and to determine differences in functional outcome.
: The medical records of eighty-eight consecutive patients who had
undergone a total of 108 iliac crest bone-grafting procedures for
the treatment of chronic osteomyelitis from 1991 to 1998 were retrospectively
reviewed. Demographic characteristics, the location of the harvest,
the volume of bone graft that was harvested, the estimated blood
loss, and postoperative complications were recorded. Fifty-eight
patients completed a questionnaire pertaining to postoperative and residual
pain, sensory disturbances, functional limitations, cosmetic appearance,
and overall satisfaction with the bone-graft harvesting procedure.
: Sixty-six anterior and forty-two posterior bone-graft harvest sites
were evaluated at a minimum of two years after the operation. A
major complication was associated with 8% (five) of the sixty-six
anterior sites and 2% (one) of the forty-two posterior sites. The
rates of minor complications were 15% (ten) and 0%, respectively.
In the series as a whole, there were ten minor complications (9%)
and six major complications (6%). The rates of both minor complications
(p = 0.006) and all complications (p = 0.004) were significantly
higher after the anterior harvest procedures than they were after
the posterior procedures. The postoperative pain at the donor site
was significantly more severe (p = 0.0016) and of significantly greater
duration (p = 0.0017) after the anterior harvests. No patient reported
functional limitations at the latest follow-up evaluation.
In this series, the complication rate was lower than those previously
reported by other investigators. Harvest of a posterior iliac crest
bone graft was associated with a significantly lower risk of postoperative
complications. On the basis of the results of this study, we recommend
that iliac crest bone graft be harvested posteriorly whenever possible.