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What is an Iliac Crest Graft?

By Carol Kindle
Updated Mar 03, 2024
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An iliac crest graft is a bone graft in which a piece of bone is removed from the upper region of the pelvis of a patient and implanted into another site within that patient's body. These bone grafts are called autografts and are used primarily to replace bone lost to injury or illness. Bone grafts are used in many parts of the body and aid in the healing of bones that have been fractured or bones that did not form properly at birth.

The ilium is the largest bone of the hip. It is made up of a right and a left half that together create the wing-shaped pelvic girdle. The iliac crest is the upper curved portion of each side of the ilium. A large surface area makes the ilium a favorable site for harvesting bone to be used for an iliac crest graft.

Bone harvested from the ilium is rich in growth factors and cells that stimulate bone growth. The iliac crest graft can serve as a framework for new bone growth between two pieces of bone. Grafts from the iliac crest can be inserted between two vertebrae when a spinal fusion is necessary to stabilize the spinal column. These grafts can also be used to repair cleft palates, fractures of long bones that will not heal, or damage to bones caused by a traumatic injury.

There are advantages of harvesting bone from the iliac crest and using it as an autograft. Implanting bone back into the same patient eliminates any rejection of the graft that could occur if the body recognizes the graft as foreign. An autograft also reduces the chances of contracting diseases from another donor.

Harvesting and implanting an iliac crest graft is a surgical procedure that is performed by an orthopedic surgeon. Patients would be under a general anesthetic and would need to spend several days in the hospital. The procedure involves two surgical sites, one site for the bone to be repaired and a second site for harvesting bone at the hip. X-rays would be ordered of the area to be repaired before and after the surgery to ensure that the graft is implanted correctly.

The surgery can be performed as an open procedure in which the surgeon makes a 2-inch (5-centimeter) incision in the skin over the hip bone. Tissue and muscles are separated and a piece of bone is cut from the ilium. This bone is shaped and implanted into its final location. Side effects of the open procedure include pain, bruising, and a chance of infection. The open procedure does allow for harvest of large amounts of bone from the ilium.

Another option for the surgery is the harvest of bone with a hollow needle or trephine. The incision in the skin is only 0.8 inches (2 centimeters), and risk of infection is greatly decreased. Recovery time is shorter and the patient usually experiences less pain with this procedure. Full recovery following an iliac crest graft could take up to three months.

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