Iliac Crest Bone Graft Harvest

Indications

Bone Graft, location of an anterior iliac crest bone graft
Location of an anterior iliac crest bone graft. Image by Plastische Anatomie des menschlichen Körpers für Künstler und freunde der kunst von Dr. Julius Kollmann o. ö. professor der anatomie zu Basel, Mit menreren hundert ….., Leipzig verlag von veit & Comp. 1910, page 510, Wikimedia Commons, Public domain.
  • Autograft for nonunion, arthrodesis and bone defects
  • Osteogenic, osteoinductive and osteoconductive
  • Alternatives include allograft, bone substitutes and reamer irrigator aspirator graft from the femoral canal
  • Vascularised iliac crest graft for selected scaphoid nonunions

Position

  • Anterior crest supine, posterior crest prone
  • Bump under the ipsilateral buttock for anterior harvest

Operative Steps

  1. Anterior, incision along the crest starting 3 cm posterior to the ASIS
  2. Protect the lateral femoral cutaneous nerve and avoid weakening the ASIS
  3. Subperiosteal exposure of the inner or outer table
  4. Harvest corticocancellous blocks or use a trephine
  5. Posterior, incision over the PSIS, staying within 8 cm to protect the superior cluneal nerves
  6. Avoid the sciatic notch and superior gluteal artery
  7. Haemostasis with bone wax or haemostatic agents
  8. Anterior crest yields up to about 30 mL, the posterior crest about twice as much
  9. Leave the crest and ASIS intact where possible, or repair an osteotomised crest
  10. Close the periosteum and fascia in layers
  11. Local anaesthetic infiltration or a catheter reduces donor site pain

Postoperative Care

  • Analgesia, early mobilisation

Complications

  • Chronic donor site pain
  • Haematoma
  • Lateral femoral cutaneous and cluneal nerve injury
  • ASIS avulsion fracture and hernia
  • Infection
  • Bowel injury and herniation through full thickness defects
  • Cosmetic contour defect
  • Sacroiliac joint injury with posterior harvest

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.