Morbidity and Complications Following Percutaneous Calcaneal Autograft Bone Harvest

Abstract

Background: Autogenous bone grafting is commonly used as an adjuvant in foot and ankle procedures. The iliac crest and tibia are common sources of autogenous bone graft but require a separate operative site and have been reported to have significant morbidity including pain, fractures, and prolonged hospitalization. Bone grafting from the posterolateral calcaneus offers advantages such as a single operative field, ability to be done under an ankle block, and a theoretical low complication rate. We report our morbidity and complications of percutaneous calcaneal autograft bone harvest in patients undergoing foot operations. Methods: Between 2006 and 2010, 6 foot and ankle surgeons performed a calcaneal bone graft on 393 patients undergoing foot procedures. Outcomes were measured through the use of a 4-question survey evaluating pain, subjective sensitivity at the incision site, numbness at the incision site, and limitation of shoe wear at a minimum of 1 year following the operation. Patient records were also examined for any additional complications that may have been reported. Results: Of the 393 patients eligible for this study, 210 patients responded at an average of 2.8 years (range, 1.2-5.8 years) after the operation (minimum 1 year). Of those, 181 patients (86.2%) reported no problems. Minor complications included 6 patients (2.9%) who experienced only incisional nerve sensitivity, 4 patients (1.9%) with only incisional pain, 4 patients (1.9%) who reported some degree of incisional numbness only, 2 patients (1.0%) who reported only shoe wear limitations, and 10 patients (4.8%) who had a combination of symptoms. Three patients (1.4%) had more significant complications, which consisted of a pathological fracture through the graft site, a calcaneal stress fracture, and 1 patient with permanent numbness along the distribution of the sural nerve. Conclusion: Calcaneal bone graft was an easily accessible source of local autogenous bone graft for foot and ankle procedures. Despite the simplicity of the procedure, minor complications are not infrequent, with 13.8% of patients reporting some residual symptoms along the lateral border of the calcaneus when bone graft was obtained through an oblique incision. Level of Evidence: Level IV, case series.