SLR - August 2012 - Matthew J. Hentges
Reference: Singleton TJ, Schuberth JM (2012). Bone graft from the distal medial tibia in foot and ankle surgery. Foot & Ankle Specialist 5(3), 168 – 174.
Scientific Literature Review
Reviewed by: Matthew J. Hentges, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA.
Podiatric Relevance:
The need for bone graft in primary and revisional foot and ankle surgery is common. A reliable source of autogenous bone graft is the distal medial tibia, which offers a significant amount of cancellous or corticocancellous graft material. This site is easily accessible and does not require an additional surgeon or surgical preparation.
Methods:
A retrospective analysis of 30 consecutive cases from a single surgeon’s practice was performed. Minimum follow-up was one year. The medical record was reviewed to obtain descriptive data regarding demographic information, medical comorbidities, procedure performed, type of bone graft used and harvest technique, utilization of other biologics, presence of union, and complications. Surgical technique for harvest of cancellous or corticocancellous autograft was also reviewed.
Results:
Thirty patients (21 female, nine male) with an average age of 52.5 years were reviewed. There were 22 cases of pure cancellous bone graft and eight cases of corticocancellous bone graft. The average size of the cortical strut was 18.7 mm in length and 11.7 mm in width, with an average surface area of 220 mm2. The absolute volume of graft material harvested was not directly measured. Additional biologics were utilized to augment the recipient site in five cases. The authors noted union in 26/30 (87 percent) cases. There were two nonunions noted in both the pure cancellous group and corticocancellous group. Three cases were considered delayed unions but went on to consolidation. There were no tibial stress fractures at the graft harvest site. There were no donor site infections, wound healing complications, superficial or deep infection, nerve complications, or persistent pain reported.
Conclusions:
Procurement of autograft from the distal medial tibia offers foot and ankle surgeons adequate amounts of pure cancellous or corticocancellous substrate needed for a majority of foot and ankle reconstruction. The results presented in this series compare favorably to those previous published.