Conversion of the monocortical iliac bone graft to the three-dimensional prism bone graft

The iliac crest is the most common bone graft donor site. However, harvesting of tri or bi-cortical iliac bone graft is associated with some potentially serious complications and cosmetic deformity. We would like to present a case in which we used a new technique converting the mono-cortical iliac graft to the three-dimensional prism bone graft in order to reconstruct an acquired first metatarsal defect and to avoid the potentially serious complication of the iliac crest bone harvest.

A six-year-old boy was referred to our institution due to the posttraumatic deformity of his left foot. He had a short big toe and dorsoflexion contracture of first metatarso-phalengeal joint due to the first metatarsus defect and previous skin graft. To reconstruct the bony defect, 4 x 3 cm monocortical bone graft was harvested from the anterior aspect of the ilium by using the peel-off technique. Then, the mono-cortical graft was converted to the prism with the appropriate osteotomies. This custom shaped tri-cortical prism bone graft was placed into the first metatarsal defect. Lateral arm fascia-cutaneous free flap was used for soft tissue reconstruction. The patient was able to walk without support and wear regular shoes and started playing freely with his friends at four months after the reconstruction.

This is a single case report and demonstrates that a successful result can be obtained with this technique. Although the prism bone graft technique seems to offer a solution to a potential rather than a real problem, it offers a thick and three-dimensional cortico-cancellous bone graft without violating the iliac crest. Thus, the risk of serious complications resulting from the tricortical iliac crest graft or bicortical full thickness graft harvesting can be eliminated. Moreover, epiphysis of the immature iliac crest can be preserved in a growing child.