Avulsion fracture of the anterior iliac crest after bone graft harvest: case report and review of techniques, risk factors, and treatment

Abstract

The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fusion in a 63-year-old man. Non-operative treatment was the method of our treatment in the patient. By means of the presented case, iliac crest bone grafting techniques, risk factors of avulsion fracture, and treatment options were reviewed. KeywOrds: Bone transplantation, Cervical vertebrae, Iliac crest, Postoperative complications, Spinal fusion ÖZAnterior iliak kıyı, nitelik ve nicelik olarak iyi bir kemik ve kolay alınabilir olması nedeniyle greft yeri olarak çoğu cerrah tarafından tercih edilmektedir. Spinal füzyon icin kemik alınmasını takiben iliak kıyı kırığı gelişmesi oldukça nadir gelişen bir durumdur. Anterior servikal füzyon için kemik greft alınmasını takiben anterior iliak kıyı kopma kırığı gelişen 63 yaşında bir erkek hasta sunulmuştur. Hastadaki tedavi metodumuz ameliyat dışı tedavi oldu. Sunulan olgu aracılığıyla iliak kıyıdan greft alma teknikleri, kırık için risk faktörleri ve tedavi seçenekleri gözden geçirildi.

Avulsion fracture of the anterior superior iliac crest following autograft for anterior lumbar fusion: case report and literature review

“…As a fusion material, autologous bone graft has become the gold standard for all spinal fusion surgeries due to its excellent properties of osteoconduction, osteoinduction, and osteogenesis ( 9 ). The anterior or posterior iliac crest is the most common donor site used by spinal surgeons.…”

“…Unlike oral and maxillofacial surgery and anterior cervical fusion, ALF usually requires significantly larger tricortical bone blocks. When these blocks are harvested from the ASIC, the attachment area of the hip flexors is significantly reduced, and the strength of contraction of the sartorius and tensor fascia latae muscles attached to the ASIC may cause avulsion fracture of residual bone after bone harvesting when the patient starts to walk postoperatively ( 9 ). In addition, patient-related factors, such as older age, lower weight, osteoporosis, and anorexia nervosa, have been identified as risk factors for fracture of the ASIC ( 8 , 24 ).…”

“…To date, more than 50 cases of iliac crest fractures after bone harvest have been reported, of which 28 were in the anterior part of the iliac crest (24). Among them, fracture of the ASIC harvested for spinal fusion surgeries is extremely rare; to our knowledge, there have been only 8 reports to date (8)(9)(10)(11)(12)(13)(14)(15), as shown in Table 1. Of the 8 reports, only one reported avulsion fracture of ASIC occurred following ALF, the rest of them were all for cervical surgery.…”

“…Various complications at the iliac crest donor site, including refractory pain, neurovascular injury, infection, hematoma, and bowel herniation, have been reported (6,7). Among these, avulsion fracture of the anterior superior iliac crest (ASIC) after bone harvest for spinal fusion is a very rare complication and, to our knowledge, only eight cases have been reported to date (8)(9)(10)(11)(12)(13)(14)(15), and only one was for anterior lumbar fusion (ALF) (14). Here, we report the second case of avulsion fracture of the ASIC following autograft for ALF in a revision surgery to treat lumbar tuberculosis, which was successfully managed by open reduction and internal fixation.…”