Comparison of the inner side and two-sided approaches for iliac crest bone graft harvesting for pediatric pelvic osteotomy

BACKGROUND: The iliac crest is one of the most used bone graft sources. In this study, we aimed to identify the effects of inner side and two-sided approaches for iliac crest bone harvesting on post-surgery ilium growth in children. MATERIALS AND METHODS: We retrospectively analyzed 47 patients who underwent pelvic osteotomy and iliac crest bone graft (ICBG) procedures from January 2015 to September 2018. The patients were divided into an inner table ilium exposure group (group A) and the inner-outer table ilium exposure group (group B) and were followed up with radiography in postoperative months 1, 3, 6, and 12, and the growth areas were measured using PACS software. Complications such as damage to the arteries or nerves, ureteral injury, gastrointestinal hernia, ileus, abnormal cosmetic appearance, sensory disturbances, and functional limitations were recorded based on clinical records. RESULTS: There were 22 patients aged 5.3±1.5 years in group A and 25 patients aged 5.9±1.8 years in group B. There were no significant differences in demographics between the two groups, or in growth in the first month. However, bone graft growth at months 3, 6, and 12 was significantly better in group A than in group B. There was no significant difference in complications between the two groups. CONCLUSION: Exposure of only the inner table of the ilium resulted in faster recovery of the bone defect than two-sided exposure in pelvic osteotomy. Therefore, we suggest protecting the outer side of the ilium during surgery. LEVEL OF EVIDENCE: Level III