Unusual complications at iliac crest bone graft donor site: experience with two cases

Two cases of fracture of the iliac crest after graft harvesting are presented. Only six such cases have been reported in the literature, although more than 100,000 such procedures are performed each year in the United States alone. This complication adds to the morbidity of the procedure for which the graft is taken. Its avoidance by an appropriate harvesting technique will reduce patient disability and shorten hospital stay.

A 56-year-old man who worked as a mechanic underwent anterior cervical discectomies and fusion at C5-C6 and C6-C7 for spondylotic radiculopathies. Another patient, a 48-year-old man, required mandibular reconstruction for squamous cell carcinoma. Both grafts were harvested from the iliac crest using osteotomies. On the 9th and 3rd postoperative days, respectively, each patient developed groin pain while walking, associated with marked tenderness over the graft donor sites. X-rays showed fractured iliac crests.

Apart from bed rest for pain, no specific treatment was required.

The use of the osteotome weakens the iliac crest, leading to stress fractures caused by the pulling action of the attached muscles. To prevent this from happening, we recommend the use of the oscillating saw, leaving a 3-cm spike of iliac crest anteriorly. Nevertheless, this complication has a good long-term outcome.