I’m doing some research on the Internet about bone grafting. I may have to have this done if the break in my leg bone doesn’t start healing up better than it is. I keep seeing reference to “minor” and “major” complications. It sure seems to me like they all sound major. How are these different?

You bring up a very good point. Complications around bone grafts may definitely seem like a major thing to the patient whereas the surgeon classifies them according to cost, need for a second hospitalization or repeat surgical procedure, and risk for long-term disability.

Donor bone comes from two sources: a bone bank (called allogeneic bone graft) or from the patient (autogenous bone graft). The most common problem with allogeneic bone bank graft material is rejection by the patient. The donor cells and the patient’s cells just aren’t compatible enough.

Autogenic bone grafts are preferred and can be taken from several areas such as the upper or lower part of the tibia (lower leg bone), radius (forearm bone) near the wrist, and the outer portion of the hip. But bone is taken most often from the pelvis because it is easy to access and it has different types of bone cells (e.g., osteoclasts, osteoblasts).

The bone collected there is biologically active and stays alive long enough to create more bone cells. That’s important in order to have fast bone remodeling. Having both types of bone cells also means the graft site will stable immediately.

With any autogenous bone grafts, there can be problems. Rejection isn’t usually one of them. The biggest complication is pain at the donor site. In fact, many patients say the donor graft site was the worst part of the entire procedure!

Other complications of bone grafting include deep infection (which can cause graft failure), nerve damage, hematoma (pocket of blood), and bone fracture at the donor site. The surgeon can prevent graft failure with proper handling of the graft material. It must be kept moist and used right away whenever possible.

For any of these problems, they are considered “minor” if you don’t need further medical treatment. Hematomas will eventually resolve on their own. Symptoms from nerve damage usually go away too as the nerve regenerates. But deep infection that requires another operation or permanent nerve damage that results in a limp would be considered a “major” complication.

Studies show that most of the bone graft complications are “minor” (as defined medically). Major complications are much less common. There are single cases reported sometimes for problems like joint instability or ureteral injury (the ureter is the tube that goes from the kidney to the bladder). Such complicatons would be considered major by both patient and surgeon.

Efforts are underway by the surgical community to find improved safe, but effective ways to conduct all bone graft procedures. The goal is to enhance bone formation with the fewest side effects or problems. Certainly, long-term pain and disability is to be avoided.