Donor site morbidity after autologous bone graft harvesting for fracture nonunion: a systematic review and comparative analysis of four techniques

Introduction: Autologous bone grafting is the reference standard for fracture nonunion; however, donor site morbidity remains a primary concern across all harvesting techniques.

Sources of data: 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 al., 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.

Areas of agreement: 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-irrigator-aspirator (RIA) (P = .0008) and between ICBG and PK (P < .0001).