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Year |
2001 |
|---|---|
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Question Number |
251. |
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Category |
Select |
Question
During harvest of an anterior iliac crest bone graft, what nerve is at greatest risk for injury?
a. Lateral femoral cutaneous
b. Inguinal
c. Genitofemoral
d. Ilioinguinal
e. Femoral
Figures
Answer (click for answer)
Answer: A
Anteriorly, the neurovascular structures adjacent to the ilium include the lateral femoral cutaneous(L2,3), iliohypogastric(T12, L1), and ilioinguinal (L1) nerves. Posteriorly, the superior cluneal nerves (L1,2,3) and superior gluteal n (L4,5, S1) and superior gluteal a (branch of internal iliac(hypogastric)artery) are at risk. The lateral femoral cutaneous n usually exits the iliac fossa from beneath the inguinal ligament, however, it often branches and also exits over the ASIS, placing it at high risk for injury during anterior iliac crest bone harvest.
Reference: Netter, Frank: Atlas of Human Anatomy, pp466-467.
Ebraheim, Nabil, et al: Bone Graft harvesting from the Iliac and fibular donor sites: techniques and complications, JAAOS 9(3):210-218.