The use of autograft bone is the best option when undertaking a procedure that requires bone graft because it is osteogenic, osteoconductive and osseo-inductive. Pain, morbidity and complications associated with harvesting iliac or non-iliac sites occur in between 6% and 30% of cases. An alternative source of graft with possibly a lower morbidity is the intramedullary canal. In this study, 28 patients undergoing 30 arthrodesis procedures on the hindfoot had a mean of 48 cm3 (43 to 50) of bone harvested locally from the hindfoot or the tibial shaft by antegrade or retrograde reaming. No patient sustained a fracture of the calcaneum, talus or tibia. There was no morbidity except for one complication when the reamer breached the medial tibial cortex. This healed uneventfully.
This method of using the reamer–irrigator–aspirator system is an extension of the standard technique of intramedullary reaming of the lower limb: it produces good-quality bone graft with viable growth factors consistent with that of the iliac crest, and donor site morbidity is low. This is an efficient method of obtaining autologous bone for use in arthrodesis of the ankle or hindfoot.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Supplementary material. Photographs and fluoroscopic images of A1) the knee position and incisions and A2) the placement of the pin and reamer for the antegrade approach, A3) the RIA being used from an antegrade approach, and A4) the placement of pins for the retrograde approach, are available with the electronic version of this article on our website www.jbjs.org.uk
- Received June 1, 2011.
- Accepted September 23, 2011.
- ©2012 British Editorial Society of Bone and Joint Surgery