Proximal tibial metaphysis: its reliability as a donor site for grafting

The iliac crest and the proximal tibial metaphysis are the commonest sites for harvesting bone grafts. However, obtaining bone grafts from these sites may be associated with significant morbidity.

To study the pattern of complications encountered at each donor site and to determine the reliability of the proximal tibia as a donor site.

This was a prospective study of all patients who had bone graft harvested from the iliac crest or the proximal tibia at the National Orthopaedic Hospital, Lagos between January 2006 and December 2006. All consecutive patients who were to undergo bone grafting were reviewed preoperatively. Intra-operatively, the amount of blood loss and volume of graft harvested and the time taken to harvest it were noted. All intra-operative complications were also recorded. The immediate post-operative pain was assessed and any other complications at the donor sites were noted. They were followed up monthly in the outpatient clinic for six months.

A total of 74 patients were studied. The age range was 16-72 years with a mean of 39.7 ± 12.3 years. The male:female ratio was 1.1:1. The commonest indication for cancellous bone graft was femoral fracture nonunion. Harvesting of iliac crest bone graft took a significantly longer time and was associated with more intra-operative blood loss and post-operative pain.

The commonest indication for cancellous bone graft is femoral fracture nonunion. Harvesting of bone graft from the proximal tibial metaphysis is associated with less morbidity than the iliac crest.