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Iliac Crest

crista iliaca

The iliac crest is the curved superior border of the ilium, extending from the anterior superior iliac spine (ASIS) anteriorly to the posterior superior iliac spine (PSIS) posteriorly. The outer lip provides attachment for the tensor fasciae latae, the gluteus medius, and the external oblique; the inner lip for the iliacus and internal oblique; the intermediate zone for the transversus abdominis. The iliac tubercle (approximately 5 cm behind the ASIS) is the widest lateral point.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The iliac crest is the most common donor site for autologous bone graft in orthopaedic and oral/maxillofacial surgery. Anterior iliac crest graft is harvested 2 cm posterior to the ASIS; posterior crest graft (richer in cancellous bone) is harvested posterior to the PSIS. Donor site morbidity includes chronic pain (20%), haematoma, nerve injury, and hernia. The lateral femoral cutaneous nerve (2 cm medial to ASIS), the cluneal nerves posteriorly, and the ilioinguinal nerve along the inner crest are at risk during harvest.

Pathology

Common Injuries & Conditions

Iliac Crest Bone Graft Donor Site Morbidity

Anterior iliac crest bone graft harvest produces donor site pain in up to 20% of patients at one year, with risk of lateral femoral cutaneous nerve injury from harvesting too close to the ASIS, haematoma, and rarely hernia through the thinned outer cortex, managed by meticulous closure in layers and avoiding dissection within 2 cm of the ASIS.