Iliac Crest Biopsy and Tetracycline Labeling

Performing A Iliac CrestBiopsy

Heikki Kröger
University of Eastern Finland and Kuopio University Hospital

Iliac biopsy may be taken either from the vertical wing of the iliac bone or horizontally, transiliacally, through the wing of the iliac bone. The latter is the preferable technique, since it makes the sampling easier and provides whole samples (both cortexes included in the sample).

The inner diameter of the bone biopsy drilling trephine should be 5 mm when using the vertical sampling technique and 7 mm when using the horizontal technique. When using the horizontal technique the length of the sample depends on the thickness of the wing of the iliac bone. When using the vertical sampling technique the biopsy should be 2-3 cm long. If a bone biopsy drill is not available, sample can be taken on top of the wing of the iliac bone by a chisel.

Location of the biopsy is abut 2-3 cm backwards from the iliac anterior superior. Location of horizontal biopsy is 2 cm downwards from this point. Patient is lying on her back and slight elevation is recommended under the pelvis. Cleaning and covering should be done by using the aseptic technique used at operating theatres.

In addition to the skin and subcutis, the periosteum has to be given local anesthetic at both sides by using a long needle. Short i.v. anesthesia is commonly used in addition.

Skin cut is normally about 2 cm using vertical technique,  surface of the periosteum is exposed by scissors and opened by a scalpel. By using the horizontal technique it is possible to proceed to the surface of the iliac bone wing by using a perforator installed into the outer troacar.

Biopsy will be taken avoiding excessive force, which usually breaks the sample. Outer troacar must be placed close to the bone. A saw edged trephine is assembled into the outer troacar and the biopsy is taken by turning it lightly.

When using horizontal technique the trephine should be turned lightly a few times after the resistance has disappeared. Thereafter the trephine is removed by turning it anticlockwise. When using vertical technique it is important to stay between the crest wings. After proceeding 2-3 cm biopsy will be loosened by lightly turning the trephine.

Biopsy site may be filled with bone wax or Surgigel through the outer troacar. Wound will be closed layer by layer and compressive bands applied. Stitches will be removed after 7 days.

Bone sample will be stored in 70-80 % alcohol and immediately sent for histomorphometric examination to:

University of Eastern Finland
SIB-Labs / Ritva Savolainen
Snellmania Building
P.O.Box 1627
FI-70211 Kuopio, FINLAND

Tetracycline labeling is performed before the biopsy as follows:

  • An appointment will be made for the patient for the procedure for the outpatient procedure. Patients undergoing operations will have stamping before the operation
  • Attn! Labeling will take about three weeks (20-23 days)
  • Patient will receive tetracycline tablets (or prescription for them) and she/he will be asked to take the tablets according to instruction
  • The days will be recorded on the patient instructions
    • Oricyclin/Apocyclin tabl 500 mg 3 times daily for 2 days (6 tables in total)
    • 10 days break
    • Oricyclin/Apocyclin tabl 500 mg 3 times daily for 2 days (6 tables in total)
    • 5-14 days break
    • Biopsy
  • Patient should not use milk products, antacids or iron medication during 2 hours before and after taking the tablets

BONE SAMPLE – patient instructions

We are planning to take a bone sample from you for microscopic examination. Sample (about 5-7 x 20 mm) will be taken from pelvic bone by using local anesthesia/short general anesthesia.

Before sampling you should take Oricyclin (or Apocyclin) tables according to the following instructions. It is an ordinary tetracycline antibiotic, which acts as a marker substance, when examining the bone metabolism.

Tablets should be taken as follows:

____ 1 tabl 3 times daily [   ]
____ 1 tabl 3 times daily [   ]

10 days break

____ 1 tabl 3 times daily [   ]
____ 1 tabl 3 times daily [   ]

5-10 days break

Date of the bone sample:     ____ /____

Tables can be taken with food, but you should not use any milk products, antacids or iron medication for two hours before and after taking the tablets. Tablets may be taken e.g. at 8, 14 and 20.

Be careful to take the tables and record their intake into this form to avoid forgetting.
Form should be returned, when coming to the operation.