Complications of iliac crest graft and bone grafting alternatives in foot and ankle surgery

The ability to harvest iliac crest bone is a well-established skill in the surgical armamentarium of the orthopedic surgeon. As with any surgical procedure, this operation has its own set of complications. The surgeon must be aware of these potential problems in an effort to avoid them when possible. Other autologous sites for bone harvest are available to the surgeon, and s/he should be aware of these in terms of location, limitations of use, harvest technique, and potential pitfalls. The foot and ankle surgeon almost always needs less bone graft than our colleagues in spine surgery or joint revision surgery, so these other sites may be more suitable than the iliac crest for obtaining bone graft. Nonautogenous alternatives are becoming increasingly available to the orthopedist as a way to decrease morbidity and operating times. Scranton recently published an article about his success with several different bone substitute products that are used in foot and ankle reconstructive cases. As these options become more varied, it becomes more difficult to know which product to select. Understanding the biology of bone grafting with respect to osteoconduction, osteoinduction, and osteogenesis provides the surgeon with the knowledge that is needed to make an informed choice when selecting a bone grafting option. Before choosing an alternative graft material, the surgeon should also investigate how the graft material has performed in cases similar to his or her patient's needs. In the future, with continued research, the fields of tissue engineering and gene therapy will provide even better options for nonautogenous bone graft material.