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. 2008 Dec;466(12):2973-80.
doi: 10.1007/s11999-008-0538-3. Epub 2008 Oct 8.

Bone graft harvest using a new intramedullary system

Mohan V Belthur  1 , Janet D Conway, Gaurav Jindal, Ashish Ranade, John E Herzenberg
Affiliations

Bone graft harvest using a new intramedullary system

Mohan V Belthur et al. Clin Orthop Relat Res. 2008 Dec.

Abstract

Obtaining autogenous bone graft from the iliac crest can entail substantial morbidity. Alternatively, bone graft can be harvested from long bones using an intramedullary (IM) harvesting system. We measured bone graft volume obtained from the IM canals of the femur and tibia and documented the complications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used.

Level of evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
The patient is positioned supine on the radiolucent table with the leg adducted, and the anatomic axis of the femur is marked in both planes. The level of the greater trochanter is marked. The minimally invasive approach is shown.
Fig. 2
Fig. 2
The Reamer/Irrigator/Aspirator (RIA) system consists of: A, a reamer head; B, collection tube outside the drive shaft; C, aspiration port; D, irrigation port; E, drive shaft seal.
Fig. 3
Fig. 3
Photograph shows the RIA system assembled with the capturing system and filter.
Fig. 4A–B
Fig. 4A–B
(A) The intramedullary bone graft is transferred from the capturing system to a (B) measuring bottle.
Fig. 5A–B
Fig. 5A–B
(A) Anteroposterior and (B) lateral view radiographs show the distal femur. The arrows show the perforation in the anterior femoral cortex.
Fig. 6A–D
Fig. 6A–D
(A) Anteroposterior view fluoroscopic image of the proximal femur shows the piriformis entry point. (B) Anteroposterior view fluoroscopic image shows aggressive reaming of the femoral neck (arrow). (C) Anteroposterior and (D) lateral view fluoroscopic images show prophylactic fixation with cannulated cancellous screws.
Fig. 7
Fig. 7
The total pain scores reported by patients in the iliac crest bone graft (ICBG) group were compared with the scores reported by the reamer/irrigator/aspirator (RIA) group. Patients were asked during a telephone survey to report their pain intensity and frequency of pain less than 48 hours, from 48 hours to 3 months, and more than 3 months after the procedure. Patients in the RIA group experienced substantially less pain during all three time periods.
See this image and copyright information in PMC

Comment in

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