UNUSUAL COMPLICATIONS AT ILIAC CREST BONE-GRAFT DONOR SITE - EXPERIENCE WITH 2 CASES

OBJECTIVE AND IMPORTANCE: Two cases of fracture of the iliac crest aft er graft harvesting are presented. Only six such cases have been repor ted in the literature, although more than 100,000 such procedures are performed each year in the United States alone. This complication adds to the morbidity of the procedure for which the graft is taken. Its a voidance by an appropriate harvesting technique will reduce patient di sability and shorten hospital stay. CLINICAL PRESENTATION: A 56-year-o ld man who worked as a mechanic underwent anterior cervical discectomi es and fusion at C5-C6 and C6-C7 for spondylotic radiculopathies. Anot her patient, a 48-year-old man, required mandibular reconstruction for squamous cell carcinoma. Both grafts were harvested from the iliac cr est using osteotomes. On the 9th and 3rd postoperative days, respectiv ely, each patient developed groin pain while walking, associated with marked tenderness over the graft donor sites. X-rays showed fractured iliac crests. INTERVENTION: Apart from bed rest for pain, no specific treatment was required. CONCLUSION: The use of the osteotome weakens t he iliac crest, leading to stress fractures caused by the pulling acti on of the attached muscles. To prevent this from happening, we recomme nd the use of the oscillating saw, leaving a 3-cm spike of iliac crest anteriorly. Nevertheless, this complication has a good long-term outc ome.