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National Journal of Maxillofacial Surgery
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Table of Contents
Year : 2012  |  Volume : 3  |  Issue : 2  |  Page : 239-241  

Tibial shaft fracture following graft harvestment for nasal augmentation

Department of Oral & Maxillofacial Surgery, AME'S Dental College Hospital & Research Centre, Raichur, Karnataka, India

Date of Web Publication4-May-2013

Correspondence Address:
Yadavalli Guruprasad
Department of Oral & Maxillofacial Surgery, AME'S Dental College Hospital & Research Centre, Raichur, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-5950.111398

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How to cite this article:
Guruprasad Y, Chauhan DS. Tibial shaft fracture following graft harvestment for nasal augmentation. Natl J Maxillofac Surg 2012;3:239-41

How to cite this URL:
Guruprasad Y, Chauhan DS. Tibial shaft fracture following graft harvestment for nasal augmentation. Natl J Maxillofac Surg [serial online] 2012 [cited 2022 Dec 4];3:239-41. Available from: https://www.njms.in/text.asp?2012/3/2/239/111398


Bone grafts are the best option for reconstruction of wide defects of the nose with autogenous tissue, maintaining the tip projection with minimal airway problems. The tibial shaft is a useful site for autologous graft harvesting especially for nasal augmentation and has reduced many of the problems associated with conventional sites of autogenous grafts such as the iliac crest. [1] The ease of access for harvesting, the speed of the operation, and the abundance of bone, are advantages of this donor site. [1] We report a patient who had a graft taken from the tibial shaft and had a displaced fracture one week later after a fall.

A 21 year old female patient was admitted to department of oral and maxillofacial surgery for correction of saddle nose deformity and was planned for nasal augmentation using cortical tibia bone graft under general anesthesia. The graft was obtained by a minimal 2.5-3 cm transverse pretibial cutaneous incision placed at the upper third of the tibial diaphysis [6 cm under anterior tibial tuberosity (ATT)]. The cranial limit of the bone osteotomy was 3 cm under the ATT and the outer limit was the tibial crest. The tibial crest and the tibial tuberosity are preserved. After the skin incision, we performed a subperiosteal dissection of the bone, using no.702 straight fissure bur a rectangle measuring about 3.5×1.2 cm cortico-cancellous bone was harvested and the incision was closed in layers. The patient was allowed to bear light weight and had an uneventful hospital stay. One week after the operation, she had a fall while trying to get down from the stairs thus fracturing her right tibia through the harvest site [Figure 1] and [Figure 2]. She was operated by an orthopedic surgeon with open reduction and rigid internal fixation and partial weight bearing was recommended for 6 weeks. Passive and active knee movements were started immediately after operation. The fracture healed uneventfully.
Figure 1: Anterioposterior radiograph of tibia and fibula showing the site of graft harvestment on the tibial shaft

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Figure 2: Lateral radiograph of tibia and fibula showing the site of graft harvestment on the tibial shaft. Note the fracture line running medio-laterally through the graft site

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Tibial shaft fracture following graft harvestment is very rare and few cases have been reported in the literature. Van Damme reported two cases of tibial fractures within a week of harvesting bone from the tibia. [2] These fractures occurred during tennis playing and running, respectively, so he concluded that sports such as running and jumping should be avoided for at least 4-6 weeks postoperatively. [2] The tibial shaft is an excellent source of bone grafting material. Large amount of cortico-cancellous tibial bone is accessible, are easy to handle and compress into the recipient site, and will revascularise quickly. [3] There is also less morbidity at the donor site than after grafts from the iliac crest. The most common complications after harvest from the tibia are wound infection, haematoma, and ecchymosis. [3] We consider that the fall in our case was a major contributing factor to the fracture, but other factors such as the design of the cortical bone window, technique and volume of bony harvest, sharp line angles at the donor site and immediate weight bearing must also be considered. We removed a rectangular cortico-cancellous bone and reports on the effects of a rectangular defect in bone suggest that the bone's strength was considerably reduced by the rectangular defect. However, several other studies [4],[5] have advised a period of partial weight bearing initially followed by 3 months avoidance of contact sport.

   References Top

1.Thor A, Farzad P, Larsson S. Fracture of the tibia: Complication of bone grafting to the anterior maxilla. Br J Oral Maxillofac Surg 2006;44:46-8.  Back to cited text no. 1
2.van Damme PhA. Fracture of the tibia after the modified tibial bone graft harvesting technique. A report of two cases. J CraniomaxillofacSurg1998;26(Suppl 1):197.   Back to cited text no. 2
3.Tessier P, Kawamoto H, Matthews D, Posnick J, Raulo Y, Tulasne JF, et al. Taking tibial grafts in the diaphysis and upper epiphysis-tools and techniques: IV. A 650-case experience in maxillofacial and craniofacial surgery. Plast Reconstr Surg 2005;116(5 Suppl):47S-53S.  Back to cited text no. 3
4.Marchena JM, Block MS, Stover JD. Tibial bone harvesting under intravenous sedation: Morbidity and patient experiences. J Oral Maxillofac Surg 2002;60:1151-4.  Back to cited text no. 4
5.Clark CR, Morgan C, Sonstegard DA, Matthews LS. The effect of biopsy-hole shape and size on bone strength. J Bone Joint Surg Am 1977;59:213-7.  Back to cited text no. 5


  [Figure 1], [Figure 2]

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[Pubmed] | [DOI]


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