Anterior iliac crest bone graft - Anatomic considerations

Study Design. A morphologic study of the anterior part of the iliac crest was performed. Objective. To define the anatomic characteristics of the anterior part of the ilium and to determine an optimal area to harvest the iliac bone graft from the anterior iliac crest. Summary of Background Data. Stress fracture or avulsion fracture of the anterior iliac crest and the optimum starting point of the anterior cut for anterior iliac crest graft have been noted previously. However, there is insufficient published information on the morphology of the anterior part of the ilium relative to the optimal location of harvesting the bone graft. Methods. Direct measurements using digital calipers were taken from 30 dried human pelves and 10 cadaveric pelves. The thickness of the anterior part of the ilium was measured, with different starting points on the iliac crest. The length of the bicortical iliac bone graft also was determined. Results. The thickest portion of the ilium was 16.9 +/- 2.3 mm at the iliac tubercle, which was 45% thicker than at a point 3 cm posterior to the anterior superior iliac spine. The thick region of the anterior iliac crest extended 54.0 +/- 10.2 mm posteriorly from a point 3 cm posterior to the anterior superior iliac spine. The mean length of a 10-mm thick bicortical iliac tubercle bone graft was 36.8 +/- 8.7 mm. Conclusions. The region around the iliac tubercle is suitable for harvesting bicortical or tricortical bone graft.