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Published on: May 25, 2012
Donor-Site Morbidity for Iliac Crest Harvesting for Pediatric Scaphoid Nonunion
Trevor Schott1, Katherine A Eisenberg2, Carley B Vuillermin2
1Harvard Combined Orthopaedic Residency Program, Harvard University, Boston, MA.
Insights
Iliac crest bone grafting for pediatric scaphoid nonunions shows a lower complication rate than in adults. Donor site pain beyond 30 days was the most common issue, affecting 4.2% of patients.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
Background:
- Iliac crest bone grafting (ICBG) is a common treatment for pediatric scaphoid nonunions.
- Previous studies in adults and pediatric spine fusions indicate high complication rates with ICBG, including donor site pain.
Purpose of the Study:
- To evaluate the donor site complication rate of ICBG in pediatric patients with scaphoid nonunion.
- To compare this rate with complications reported in other patient populations.
Main Methods:
- Retrospective review of 117 pediatric patients (ages 0-18) undergoing ICBG for scaphoid nonunion between 1995 and 2016.
- Data collected included graft harvest technique and donor site complications (pain, numbness, infection, reoperation).
Main Results:
- 119 wrists underwent internal fixation and ICBG; 8.4% experienced donor site complications.
- The most frequent complications were pain beyond 30 days (4.2%) and numbness (3.4%).
- No infections or reoperations at the donor site were recorded. Female patients had a higher complication likelihood.
Conclusions:
- Donor site morbidity associated with ICBG in pediatric scaphoid nonunion surgery is lower than previously reported in adult populations.
- The findings suggest ICBG is a relatively safe procedure for pediatric scaphoid nonunions regarding donor site complications.
Purpose:
Screw fixation with iliac crest bone grafting (ICBG) is a well-studied treatment for pediatric scaphoid nonunions. Studies in adults, as well as in pediatric spine fusions, have demonstrated high rates of complications with ICBG, including longer-term donor site pain. We hypothesized that in pediatric patients undergoing ICBG for scaphoid nonunion, the donor site complication rate would be lower than that reported in other populations.
Methods:
Records of patients ages 0-18 years at a single institution undergoing surgical reconstruction for scaphoid nonunion from 1995 to 2016 were reviewed. Patient and surgical variables were recorded, including how ICBG was harvested. Donor site complications were recorded, including donor site pain beyond 30 days after surgery, infection, peri-incisional or lower extremity numbness at any point after surgery and reoperation at the donor site at any time point after surgery.
Results:
During the study period, 119 wrists in 117 patients underwent internal fixation and ICBG for scaphoid nonunion. The average age was 16 years; mean follow-up was 1 year. The majority of wrists (73, 62.9%) underwent harvest of both outer and inner tables of the iliac crest; 38 (31.9%) had only outer table harvested; 5 (4.3%) had only cancellous graft harvested. Ten wrists (8.4%) had a donor site complication. The most common donor site complication was donor site pain beyond 30 days after surgery (5, 4.2%), followed by numbness (4, 3.4%). No infections, seromas, or reoperations at the donor site occurred. In comparison to those subjects who did not experience complications, we found no difference based on the age at surgery or the type of graft used. Female patients were more likely to have a recorded complication than males.
Conclusions:
Donor site morbidity for iliac crest grafting in pediatric patients undergoing scaphoid nonunion surgery appears to be lower than that previously reported in adult patients.
Type Of Study/Level Of Evidence:
Therapeutic IV.
