Utilization of autogenous corticocancellous bone graft from the distal tibia for reconstructive surgery of the foot and ankle

Morbidity Associated With Distal Tibial Autograft Harvest

Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to assess morbidity in distal tibial autograft harvesting associated with foot and ankle arthrodesis procedures. A retrospective analysis was performed utilizing patients treated in the last 13 years at a large, multicenter, academic, tertiary referral, research institution. Included patients were between the ages of 18 and 80 years old. One-hundred and seven patients (39 male; 68 female) underwent ipsilateral distal tibial bone graft (n = 110) harvesting to augment the index procedure. Patients were followed for an average of 11.2 months after surgery (Range: 1-73 months). The incidence rate of distal tibial stress fractures was 4.5%, with an overall postoperative complication rate of 8.2%. Overall, low complication rates associated with distal tibial autograft harvesting were found, supporting the use of the distal tibia as an appropriate site for autograft harvesting in foot and ankle surgery.

Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review

Autologous bone grafting is common in trauma and orthopaedic surgery. Both the Reamer Irrigator Aspirator (RIA) and Iliac Crest Bone Graft (ICBG) aim to obtain autologous bone graft. Although the process of harvesting a bone graft is considered simple, complications may occur. This study examined morbidity and pain at the donor site, blood loss, and iatrogenic fractures, comparing RIA and ICBG. The source of the autologous bone graft, the alternative graft sites, and the storage modalities of the harvested bone marrow were also evaluated. In May 2021, PubMed, Embase, Scopus, and Google Scholar were accessed, with no time constraints. RIA may produce greater blood loss, but with less morbidity and complications, making it a potential alternative source of bone grafting.

Bone Grafting Options

Union rates vary for arthrodesis sites and bone healing in foot and ankle surgery. The ultimate goal is to achieve complete bone healing within a reasonable time. There are many factors that surgeons cannot control, such as the patient's compliance and ability to heal. However, surgeons can control osseous preparation, stable fixation, preservation of soft tissue, and the osseous fusion initial healing environment. Modification of the healing environment can be achieved with the use of bone graft and orthobiologics. This article discusses the grafts and orthobiologics that can be used in bone healing for the foot and ankle.

Bone graft from the distal medial tibia in foot and ankle surgery

Autogenous bone graft is the ideal substrate for primary and revisional foot and ankle surgery. The distal medial tibia is an easily accessible site that provides both cancellous and corticocancellous autograft. Thirty cases of distal tibial bone graft with a minimum follow-up of 1 year are presented. There was an 86% union rate, and there were no stress fractures, persistent pain, or reported nerve injuries at the donor site. An efficient and versatile technique for harvesting both cancellous bone graft and corticocancellous graft is described. The use of distal tibial bone graft eliminates the need for a second surgeon and more lengthy harvest procedure and offers sufficient autograft material for foot and ankle applications with a low rate of complications.

LEVELS OF EVIDENCE

Therapeutic, Level IV.

Autogenous bone graft: donor sites and techniques

Autogenous cancellous bone graft provides an osteoconductive, osteoinductive, and osteogenic substrate for filling bone voids and augmenting fracture-healing.The iliac crest remains the most frequently used site for bone-graft harvest, but the proximal part of the tibia, distal end of the radius, distal aspect of the tibia, and greater trochanter are alternative donor sites that are particularly useful for bone-grafting in the ipsilateral extremity.The most common complication associated with the harvest of autogenous bone graft is pain at the donor site, with less frequent complications including nerve injury, hematoma, infection, and fracture at the donor site.Induced membranes is a method that uses a temporary polymethylmethacrylate cement spacer to create a bone-graft-friendly environment to facilitate graft incorporation, even in large segmental defects.

Revisional hindfoot arthrodesis

Salvage of a failed hindfoot arthrodesis is an extensive undertaking for the surgeon and patient. With increased morbidity and postoperative convalescence and complications, patients must understand the risk involved in this type of revisional surgery. This article provides a systematic approach to revisional hindfoot arthrodeses, focusing on patient evaluation, surgical technique, and postoperative treatment.

Local bone graft harvested from the distal tibia or calcaneus for surgery of the foot and ankle

BACKGROUND

Numerous operative procedures around the foot and ankle use bone graft to augment healing. Autologous bone graft remains the preferred type for these procedures. This can be harvested from the iliac crest, but complications are frequent. The purpose of our study was to investigate the option of harvesting the bone graft from the ipsilateral distal tibia or calcaneus.

METHOD

Bone graft was harvested in 114 patients from the distal tibia (70 patients) or calcaneus (44 patients). The patients were followed postoperatively for an average of 16 (range 5 to 28) months and were evaluated for complications (minor and major), satisfaction, and healing rates.

RESULTS

There were no major complications. Ten patients (8.7%) had minor complications including initial incisional sensitivity or local numbness, none of which affected function or required additional treatment. Satisfaction rate for the procedure was 100%.

CONCLUSION

Use of autologous bone graft harvested from the ipsilateral distal tibia or calcaneus is a safe and reliable alternative to iliac crest bone graft harvest for operative procedures of the foot and ankle.