Fracture of anterior iliac crest following bone graft harvest in an anorexic patient: case report and review of literature

INTRODUCTION: In the treatment of jaw bone atrophies autologus bone is still considered the gold standard because of its excellent osteo-conductive, osteoinductive and osteogenetic proprieties and lack of immunogenicity, which allow better graft integration and stability. Although various donor sites are available, the iliac crest represents the best source of cortico cancellous bone and literature suggests that it has low morbidity. However, this case report emphasizes that patients with systemic diseases such as anorexia should be carefully evaluated before such an operation, since unfavourable bone conditions may jeopardize the outcome.REPORT OF CASE: a 47-year-old woman needing rehabilitation of the upper arch was considered for iliac crest harvesting. She stated that she had suffered from anorexia for thirty years. A cortico cancellous block was harvested by a bone saw using an antero lateral approach to the outer table of the right anterior iliac crest. The post-operative course was uneventful, but thirteen days later, she complained of a sudden pain in the operated area and x-rays revealed a fracture of the anterior iliac crest. DISCUSSION: So far literature has mentioned 50 cases of iliac crest fractures after bone harvesting and, 28 cases among these are due to harvesting in the anterior part of the iliac crest. Several factors seem to be responsible for this complication including the area of harvesting, residual bone thickness, technique used, age and gender of the patient. To our knowledge our case is the first case of hip fracture after bone harvesting in a patient suffering from anorexia. Both low weight and osteoporosis are probably responsible for this complication. In our opinion, patients suffering from anorexia should be considered at risk for bone harvesting and an appropriate mini invasive surgical technique should be carried out instead.