Prospective Observational Study of Donor-Site Morbidity Following Anterior Iliac Crest Bone-Grafting in Orthopaedic Trauma Reconstruction Patients Bryan J. Loeffler, MD, James F. Kellam, MD, Stephen H. Sims, MD, and Michael J. Bosse, MD Investigation performed at the Department of Orthopaedic Surgery, Orthopaedic Clinical Research, Carolinas Medical Center, Charlotte, North Carolina Background: Complications associated with iliac crest bone-graft donor sites have been reported. This prospective study was conducted to determine the prevalence of pain and complications at the iliac crest donor site in patients undergoing treatment of fracture nonunion. Methods: Ninety-two patients undergoing anterior iliac crest bone-grafting for nonunion or delayed union of a long-bone fracture were prospectively enrolled. Twenty-seven patients undergoing an alternative surgical treatment were enrolled as a control group. Questionnaires including pain on a visual analog scale (0 to 10) at the donor site were completed by patients at two weeks, six weeks, three months, and one year postoperatively. Short Form-36 (SF-36) forms were completed at enrollment and at the time of final follow-up. Results: The mean pain on the visual analog scale at the donor site was 3.9 at two weeks but rapidly decreased to 1.4 at six weeks and reached 0.3 at one year or more postoperatively (p < 0.001). Only two patients (2%) reported a pain value of >3 at one year or more postoperatively. There were three deep infections (3%) at the donor site, and no patients had a permanent sensory deficit in the lateral femoral cutaneous nerve distribution. At the time of final follow-up (mean, twenty- two months), scores for the SF-36 bodily pain subscale were significantly higher in the iliac crest group than in the control group, indicating a greater improvement in overall bodily pain in the iliac crest group. Conclusions: Anterior iliac crest bone-grafting for nonunion was a well-tolerated procedure. Substantial, persistent pain at the iliac crest donor site occurred in 2% of patients. Iliac crest bone-grafting did not appear to impair function or well- being compared with alternative treatments. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. A utologous bone graft, allograft, or bone-graft substi- tutes are frequently helpful in the treatment of ortho- paedic trauma patients 1-3 . Approximately 500,000 bone grafts are performed annually in the United States 4 . Indications applicable to orthopaedic trauma surgery include bone loss, delayed bone-healing, and posttraumatic arthritis. Autogenous Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always pro- vided with the online version of the article. This article was chosen to appear electronically on August 8, 2012, in advance of publication in a regularly scheduled issue. A commentary by Thomas A. DeCoster, MD, is linked to the online version of this article at jbjs.org. 1649 COPYRIGHT Ó 2012 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED J Bone Joint Surg Am. 2012;94:1649-54 d http://dx.doi.org/10.2106/JBJS.K.00961