Methylmethacrylate reconstruction of large iliac crest bone graft donor sites

Often full-thickness iliac crest grafts are necessary for various reconstructive procedures. Sometimes large defects remain in the donor ilium subsequent to their removal. Several complications have occurred as a result of these bony defects. Although several reports have been published regarding the repair of iliac herniae, little has been written about procedures to prevent these complications. A technique was devised to reconstruct the ilium with methylmethacrylate. After preparation of the defect, malleable retractors are bent to conform to the contour of the iliac crest. Methylmethacrylate is then packed into the mold made by the retractors. After hardening, the methylmethacrylate casting of the defect is trimmed and routine soft tissue closure is performed. This technique has been used in eight patients without any complications. The appearance of the waist and crests has been excellent; there have been no fractures or displacements of the mass of cement and there have been no infections. All these reconstructions have been mechanically stressed as all patients had well molded postoperative casts and/or braces. Reconstruction of the ilium with methylmethacrylate after removal of full-thickness grafts appears to be a reliable, safe, and easy technique based on a short-term follow-up of up to three years.