Tibial versus iliac bone grafts: a comparative examination in 15 freshly preserved adult cadavers

We compared autogenous bone grafts from the proximal tibia and the anterior iliac crest under standardized conditions with regard to the attainable bone amount and the histological bone density.

In 15 freshly preserved adult cadavers, a corticocancellous block graft from the anterior iliac crest and a purely cancellous transplant from the tibia of the homolateral side were harvested respectively, with the length of the skin incision set at 6 cm for the iliac and at 3.5 cm for the tibial approach. The size of the iliac graft was defined to be between 1/3 and 1/4 of the total iliac length. At the medial tibia the maximum possible amount of cancellous bone was collected after preparation of a cortical lid. For volume determination grafts were cautiously cut up and then put in a water-filled measuring cylinder. In addition, bone density was measured by histomorphometry. The received data were statistically evaluated using the t-test for related samples at P=0.05 and Pearson's correlation analysis.

From both donor sites approximately equal amounts of bone were available. This result is neither dependent on age nor on gender. In contrast, bone density turned out significantly higher in the iliac graft, with the difference showing a significant age dependence (r=-0.556).

Provided that no cortical transplants are needed, cancellous tibial bone grafts offer an appropriate alternative to the classic iliac bone graft, especially in elderly patients.