The proximal tibia donor site in cleft alveolar bone grafting: experience of 75 consecutive cases

The optimum donor site for cleft alveolar bone grafting is still debated. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. Use of the proximal tibia as donor site is associated with few complications. The occurrence of a proximal tibia fracture following cancellous bone harvest from this site, prompted a review of the last 75 consecutive cases carried out at our unit.

The medical notes of 75 consecutive patients undergoing cleft alveolar bone graft were reviewed and postal questionnaires were sent to patient's parents and family physicians. The review focused on donor site morbidity.

Fracture of the proximal tibia, a hitherto unreported complication, occurred in two out of 75 cases (2.7%) within our series. Post-operative mobilization was achieved rapidly with normal joint function and donor site healing progressed satisfactorily in all cases. In 1 out of 75 cases the graft was repeated at a later date due to recipient site infection. The incidence of other morbidity was low with most representing local complications only. Length of hospital stay was 3 days (range 2-5 days).

Based on our findings we feel that the proximal tibia offers a reliable site for harvest of sufficient quantities of good quality cancellous bone. Recommendations are made as to the technique of bone harvest, to minimize the fracture risk.