{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:48:59Z","timestamp":1792349339210,"version":"4.4.0"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Autologous bone grafting is the reference standard for fracture nonunion; however, donor site morbidity remains a primary concern across all harvesting techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sources of data<\/jats:title>\n                    <jats:p>A systematic search of PubMed and Embase was performed from January 2011 to March 2026, chosen to capture the 15-year period since the landmark 2011 review of autograft harvest complications by Dimitriou et\u00a0al., in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 49 studies comprising 3029 graft sites across four autograft harvesting techniques were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Areas of agreement<\/jats:title>\n                    <jats:p>Complication profiles are highly technique-dependent. ICBG demonstrated the lowest overall complication rate (5.83%). Fibular strut grafts demonstrated similarly favourable morbidity (4.88%). Significant differences in overall complication rates were identified between ICBG and reamer\u2013irrigator\u2013aspirator (RIA) (P\u2009=\u2009.0008) and between ICBG and PK (P\u2009&amp;lt;\u2009.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Areas of controversy<\/jats:title>\n                    <jats:p>RIA has historically been considered lower morbidity than ICBG; however, the present analysis demonstrated a higher overall complication rate for RIA (9.40%), driven primarily by transfusion requirements (7.88%). This finding likely reflects broader use of RIA in more complex nonunion presentations and improved recognition of transfusion-related risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Growing points<\/jats:title>\n                    <jats:p>Periarticular knee harvesting demonstrated the highest overall complication rate (13.64%), challenging its perception as a uniformly low-morbidity technique. Future studies with larger per-subtype cohorts are needed to compare these independently.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Areas for developing research<\/jats:title>\n                    <jats:p>Prospective, multicentre cohort studies employing standardized complication definitions and adequate follow-up durations are needed to overcome the heterogeneity inherent to the current retrospective literature.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bmb\/ldag038","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:59:42Z","timestamp":1792346382000},"source":"Crossref","is-referenced-by-count":0,"title":["Donor site morbidity after autologous bone graft harvesting for fracture nonunion: a systematic review and comparative analysis of four techniques"],"prefix":"10.1093","volume":"160","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-1385","authenticated-orcid":false,"given":"Grayson","family":"Norris","sequence":"first","affiliation":[{"name":"Oklahoma State University Department of Orthopaedic Surgery , 744 W 9th St., Tulsa, OK 74127 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6394-7742","authenticated-orcid":false,"given":"Sean","family":"Young","sequence":"additional","affiliation":[{"name":"Oklahoma State University Department of Orthopaedic Surgery , 744 W 9th St., Tulsa, OK 74127 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7157-8696","authenticated-orcid":false,"given":"Bryce","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Oklahoma State University Center for Health Sciences , 1111 W 17th St., Tulsa, OK 74107 ,","place":["United 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