DOI: http://dx.doi.org/10.18203/2349-2902.isj20201856

Quantum of cortico-cancellous bone safe for harvest from anterior iliac wing of pediatric patients: a finite element analysis with clinical correlation

Swetha Tarun, Sneha Pendem, Krishna Kumar Raja

Abstract


Background: Objective was to assess the maximum quantum of cortico- cancellous bone that can be harvested from the Anterior Iliac Wing (AIW) of paediatric population.

Methods: All patients reporting to the unit for the correction of bilateral cleft alveolus were included. A Computed Tomogram (CT) of the hip was recorded and the volume of cancellous bone available for harvest was assessed. Finite element model of the hip was generated using D2P and Geomagic Free form software and the impact of bone harvest on stress distribution along the anterior iliac wing was assessed by substituting the muscle forces (hip abductors and sartorius group) and was clinically correlated to volume harvested and donor site morbidities.

Results: 10 patients were enrolled, 5 patients were excluded. CT volumetric evaluation revealed an average 0.5 cc to 4.7 ccof cancellous bone and 6.7 cc to 11 cc of cortical bone was available for harvest. Harvest of 50% of available graft volume was safe with minimal stress distributed along the line joining the tuberosity to the area between Antero Superior and Inferior spines (4.2 MPa at rest and 18.5 MPa at stance). The stress levels increased with increase in volume of bone harvested. Intra operatively 1.9 cc to 6.2 cc of cortico cancellous graft was harvested, which was equivalent to 60% of the graft available with no long-term morbidities.

Conclusions: The volume of bone graft harvest should be restricted (up to 6 cc) to avoid long term morbidities. 


Keywords


Anterior iliac wing, Bone graft, Cancellous bone graft, Finite element analysis, Pediatric pelvis

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References


Elsalanty M, Genecov D. Bone grafts in craniofacial surgery. Craniomaxillofac Trauma Reconstr. 2009;2(3):125-34.

Roden RD. Principles of bone grafting. Oral Maxillofac Surg Clin North Am. 2010;22(3):295-300.

Wu C, Pan W. Grafting materials for alveolar cleft reconstruction: a systematic review and best-evidence synthesis. Int J Oral Maxillofac Surg. 2018;47(3):345-56.

Yadav A, Jain A. Morbidity associated with anterior iliac crest harvesting for osseous reconstruction of alveolar clefts. J Cleft Lip Palate Craniofac Anomal. 2017;4:158.

White KK, Williams SK, Mubarak SJ. Definition of anterior superior iliac spine avulsion fracture. J Pediatric Orthopedics. 2002;22:578-82.

Aksoy B, Oztruk K, Enseyel CZ. Avulssion of illiac crest apophysis. Int J Sports Med. 1998;19:76-8.

Lambert MJ, Flinger DJ. avulssion of illiac crest apophysis: a rare fracture in adolescent athletes. Ann Emergency Med. 1993;20:1218-20.

Buch KA, Campbell J. Acute onset of meralgia paresthetica after fracture of the anterior superior iliac spine: injury. Int J Care Injures. 1993;24(8):569-70.

Neumann DA. Biomechanical analysis of selected principles of hip joint protection. Arth Care Res. 1989;2(4):146-55.

Kawamura T, Takanaka K, Nakamura T, Osumi H. Development of an orthosis for walking assistance using pneumatic artificial muscle: a quantitative assessment of the effect of assistance. Int Conf Rehabil Robot. 2013;66:503-5.

Mahran H, Alanezi M. Complications after use of iliac bone graft for post cleft alveolar bone defect. Am J Oral Maxillofac Surg. 2018;5:22-8.

Herford AS, Dean JS. Complications in bone grafting. Oral Maxillofac Surg Clin North Am. 2011;23(3):433-42.

Wouter WI, Raghoebar GM, Jansma J. Morbidity from iliac crest bone harvesting. J Oral Maxfac Surg. 1996;54:1424-9.

Fasolis M, Boffano P, Ramieri G. Morbidity associated with anterior iliac crest bone graft. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5):586-91.

Zijderveld SA, Bruggenkate CM. Fractures of the iliac crest after split-thickness bone grafting for preprosthetic surgery: report of 3 cases and review of the literature. J Oral Maxillofac Surg. 2004;62(7):781-6.

Ricci PL, Maas S, Kelm J. Finite element analysis of the pelvis including gait muscle forces: an investigation into the effect of rami fractures on load transmission. J Exp Orthop. 2018;5(1):33.

Kuraria S, Kumar V. Three dimensional finite element analysis of pelvic bone. Int J Eng Dev Resear. 2016;3:1-4.

Schmitz P, Neumann C. Biomechanical analysis of iliac crest loading following cortico-cancellous bone harvesting. J Orthop Surg Res. 2018;13(1):108.

Standring S. Gray’s anatomy. The Anatomical Basis of Clinical Practice, 40th Edition. Churchill Livingstone Elsevier. 2008.

Hermann IP. Physics of the Human Body, Biological and Medical physics: Biomedical engineering. Springer International. Switzerland. 2016:247-321.

Rendenbach C, Goehler F. Evaluation of long-term functional donor site morbidity after deep circumflex iliac crest artery bone flap harvest. Micro Surgery. 2019;39(4):304-9.