Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery

Hong-Geun Jung; Jun-Gyu Lee; Jong-Tae Park; Sang-Hun Lee; Min-Ho Shin

doi:10.4055/jkoa.2013.48.5.391

Journal List > J Korean Orthop Assoc > v.48(5) > 1013256

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Jung, Lee, Park, Lee, and Shin: Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(5): 391-396.

Published online: 25 October 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.5.391

Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery

Hong-Geun Jung, M.D., Ph.D., Jun-Gyu Lee, M.D., Jong-Tae Park, M.D., Sang-Hun Lee, M.D., Min-Ho Shin, M.D.

Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.

Correspondence to: Hong-Geun Jung, M.D., Ph.D. Department of Orthopedic Surgery, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. TEL: +82-2-2030-7609, FAX: +82-2-2030-7369, jungfoot@hanmail.net

Received 7 January 2013 Revised 2 May 2013 Accepted 16 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to evaluate clinical availability and advantage of autogenous cancellous bone graft from proximal tibia metaphysis.

Materials and Methods

A retrospective review was conducted of 58 cases of foot and ankle surgeries using bone graft from the ipsilateral proximal tibia from August 2008 to March 2012 in Konkuk University Medical Center (Seoul, Korea). The group included patients with isolated reconstructions as well as trauma in the foot and ankle area.

Results

The mean volume of cancellous bone harvested from the proximal tibia was 14 ml (range, 5 to 28 ml) and allograft was added to the autogenous bone graft in order to fill the large bone defect for six cases. The bone graft was performed for 41 arthrodesises, seven supramalleolar tibial osteotomies, eight open reduction and internal fixation procedures, and two curettage and bone grafts of bone tumor. At final follow-up, one case (1.7%) showed mild pain on the donor site and the mean visual analogue scale score for pain was 0.1 (range, 0 to 2). There was no occurrence of major post-operative complication at the donor site. Solid union at final follow-up was observed in 97% of cases.

Conclusion

Proximal tibial bone graft was found to be a viable alternative to the iliac crest bone graft in the aspect of cancellous bone graft with relatively sufficient quantity and minimal donor site morbidity.

Keywords: autogenous cancellous bone graft, proximal tibia, foot and ankle surgeries

Figures and Tables

Figure 1

Photograph shows bone graft harvest from the medial aspect of the proximal tibia. (A) A skin incision was made 3 to 4 cm longitudinally at the medial aspect of the proximal tibia. (B) A rectangular cortical window measuring 3×2 cm in size was made using a micro-sagittal saw. (C) Volume of cancellous bone graft harvested from the proximal tibia was measured in a graded bowl. (D) After gelform implantation at the site of bone harvest, the cortical window was replaced.

Figure 2

Antero-posterior and lateral radiographs of proximal tibia show bony consolidation of the cortical window. (A) Antero-posterior and lateral radiographs at one month postoperatively. (B) Antero-posterior and lateral radiographs at three months postoperatively.

Table 1

Types of Surgeries Performed with Addition of Cancellous Bone Graft Harvested from Proximal Tibia

Values are presented as number (%).

Table 2

Volume of Cancellous Bone Graft Harvested from Proximal Tibia

Values are presented as number (%).

Notes

The abstract of this article was announced at 2011 The Korean Orthopedic Association Annual Fall Congress.

References

1. Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am. 2011; 93:2227–2236.

2. Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res. 2000; 371:10–27.

3. Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am. 2002; 84:716–720.

4. DeOrio JK, Farber DC. Morbidity associated with anterior iliac crest bone grafting in foot and ankle surgery. Foot Ankle Int. 2005; 26:147–151.

5. Raikin SM, Brislin K. Local bone graft harvested from the distal tibia or calcaneus for surgery of the foot and ankle. Foot Ankle Int. 2005; 26:449–453.

6. Geideman W, Early JS, Brodsky J. Clinical results of harvesting autogenous cancellous graft from the ipsilateral proximal tibia for use in foot and ankle surgery. Foot Ankle Int. 2004; 25:451–455.

7. De Long WG Jr, Einhorn TA, Koval K, et al. Bone grafts and bone graft substitutes in orthopaedic trauma surgery. A critical analysis. J Bone Joint Surg Am. 2007; 89:649–658.

8. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma. 1989; 3:192–195.

9. O'Keeffe RM Jr, Riemer BL, Butterfield SL. Harvesting of autogenous cancellous bone graft from the proximal tibial metaphysis. A review of 230 cases. J Orthop Trauma. 1991; 5:469–474.

10. Alt V, Nawab A, Seligson D. Bone grafting from the proximal tibia. J Trauma. 1999; 47:555–557.

11. Whitehouse MR, Lankester BJ, Winson IG, Hepple S. Bone graft harvest from the proximal tibia in foot and ankle arthrodesis surgery. Foot Ankle Int. 2006; 27:913–916.

12. Mauffrey C, Madsen M, Bowles RJ, Seligson D. Bone graft harvest site options in orthopaedic trauma: a prospective in vivo quantification study. Injury. 2012; 43:323–326.

13. Engelstad ME, Morse T. Anterior iliac crest, posterior iliac crest, and proximal tibia donor sites: a comparison of cancellous bone volumes in fresh cadavers. J Oral Maxillofac Surg. 2010; 68:3015–3021.

14. Chiodo CP, Hahne J, Wilson MG, Glowacki J. Histological differences in iliac and tibial bone graft. Foot Ankle Int. 2010; 31:418–422.

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