Cm. Schnitzler et al., BONE-STRUCTURE AND TURNOVER IN THE DISTAL RADIUS AND ILIAC CREST - A HISTOMORPHOMETRIC STUDY, Journal of bone and mineral research, 11(11), 1996, pp. 1761-1768
In bone grafting procedures of the wrist, the distal radius would be a
more convenient graft donor site than the conventionally used iliac c
rest. We compared tetracycline-labeled bone biopsies hum these two sit
es in 18 white patients (12 males, 6 females, aged 26-66 years) underg
oing bone grafting procedures of the wrist. Fourteen had had previous
trauma, 1 osteonecrosis of the lunate, 2 mild rheumatoid arthritis, an
d I a brachial plexus palsy. The specimens were processed undecalcifie
d and examined by routine histomorphometry for bone structure, static
and dynamic bone turnover variables, and marrow cellularity. We found
that bone from the distal radius had thinner cortices (p = 0.0001), lo
wer bone volume (p = 0.01), thinner trabeculae (p = 0.029), greater tr
abecuIar separation (p = 0.015), and lower wall thickness (p = 0.0001)
, marrow cellularity (p = 0.0001), osteoid volume (p = 0.01), osteoid
surface (p = 0.02), osteoid thickness (p = 0.0002), osteoblast surface
(p = 0.001), eroded surface (p 0.01), osteoclast surface (p = 0.012),
mineral apposition rate (p = 0.0002), double-labeled surface (p = 0.0
005), single-labeled surface (p = 0.006), bone formation rate (p = 0.0
005), adjusted apposition rate (p = 0.0001), longer mineralization lag
time (p = 0.012), and greater activation frequency (p = 0.003). Prolo
nged mineralization lag time in the radius was associated with thin os
teoid seams and low adjusted apposition rates and was therefore attrib
utable to a low level of osteoblast activity rather than to osteomalac
ia. We conclude that bone hum the distal radius was structurally infer
ior to and had lower turnover than the iliac crest bone. We suggest th
at ,where a graft has to provide immediate structural integrity, the i
liac crest is the preferred donor site. However, where bone graft is t
o be compacted into a small cavitary defect, distal radial bone may be
an adequate alternative. A clinical. study is needed to confirm this
assumption.