CHOICE

OF

ONE

AND

ITS

FATE

ALREADY

NOTED

FIRST

CHOICE
IS

OF THE BONE GRAFT DONOR AREA

PREFERRED
IN

IS

NOT UNANIMOUS GOUS GRAFTS

LAPETIENCES NOT SUTVIVC AS

AUTOGENOUS
STATED

BY MOST OVER

HOMOLO

STELIMACH

1964

WITH PRESERXED BONE WERE NOT SUCCESSFUL SINCE THE BONE GRAFT DID

RIB
THERE

ILIAC
IS

CREST

TIBIA

AND VONSCR
AS TO THE

ALL

HAVE

THEIR

CHAMPIONS
ITS

YET

ARGUMENT EVEN

TYPE OF GRAFT AND

PLACEMENT

13

SOME SURGEONS
SOMC
SPCCIAL INSIST

PREFER FULLTHICKNESS THE ADDITION OF SPLIT

RIB
IS

WHILE OTHERS

SPLIT

THE RIB

AND

ON

OF CHIPS
STRUTS

DAVID MATTHEWS
TO
FIT

DESCRIBED DEFECT

TAILORING

RIBS

INTO

THE ALVEOLAR
LITTLE

IN

THE

YOUNG

THIN
ITS

AND LEAN
REPORTED

WITH
PARTIAL

VERY

CANCELLOUS IN
EARLY

BONE HENCE
UNDUE

PROBABLY
IN

ABSORPTION SPARED

PRIMARY GRAFTING
SACRIFICE

GENERAL COSTAL

BONE CAN BE
IN
ITS

WITHOUT
SLEEVE

SINCE THE RIB WILL

REGENERATE

PERIOSTEAL

WITH
RIB
IS

PROPER INSTRUMENTS

UP

TO

CAN BE HAZARD

REMOVED THROUGH
THAT

60CM OF RIB OR 120 CM OF SPLIT CM INCISION OPENING THE PLEURA

RARELY RIB

SHOULD OCCUR
ANESTHESIA

AND
IS

CAN

BE HANDLED
CHOICE
IN

WITH

POSITNE
GRAFRI

PRESSURE

SPLIT TEST

GOOD

BONE

NG AND HAS STOOD THE

INCLUDING

OF

TIME

BECAUSE THERE HAVE BEEN

OF

PROBLEMS
KCIR
UDN

RESORPTION OF

THE THE
RIB

WORK

JOSEPH
OF

REICHMAN
PENNSLVANIA
IS

AND

WHIRAKER
FATE

UNIVERSITY
GRAFTS

IN TH

OF

AUROGENOUS

IN

RABBITS

OF INTEREST

THE

VARIOUS

TYPES

OF RIB

INSERTED GRAFT WERE INJECTED

INTO DYES

SUBPERIOSTEAL

POCKET AND THE AND EXAMINED

ANIMALS
IT

WITH

VITAL RIB

AND THEN KILLED

WAS FOUND BONE

SPLIT

THAT SPLIT CHIPS

WITH THE MARROW FACING

IN

BONE

HEALED

THE BEST

MM
THE

LENGTH
IN

WERE ALMOST
CONTACT

COMPLETELY ICSORBED
SOFT TISSUE

RIBS RIB

WITH

MARROW

WITH AND

AND FULLTHICKNESS
OF RESORPTION

DEMONSTRATED POOR HEALING

HIGH

RATE

ILIUM
THE
CREST

OF

THE
IS

ILIUM

IN

THE

YOUNG

OFFERS

POOR MATERIAL
THREAT TO

AND

SURGERY CENTERS

HERE

CONSIDERED

BY SOME SURGEONS

GROWING BONE

GEORGIADE
INFERIOR

PICKRELL TO THE

AND QUINN
ILIAC

PREFER

CANCELLOUS

FROM AN AREA
THERE
THIS

CREST

THE

FEEL

IS

PROBABLY MORE RAPID

OF GRAFT
IS

CALCIFICATION

WITH

NEW HONE FORMATION WHEN

TYPE

USED 12

THE
YEARS

ILIUM

OFFERS

AN EXCELLENT
IN

SOURCE

AFTER

THE AGE OF 10

TO

AND ESPECIALLY

THE

ADULT BUT THE DISCOMFORT AND GENERAL THAN WITH

THE RIB

MORBIDITY

HAVE BEEN

GREATER

AND 1LOGEMAN JACOBSSON

SARN

OF THE

UNIERSITY

HOSPITAL
MAXILLA

IIALM6
THC
USC

SV EDEN NOTED
OF GIAFTS

IN

172
ILIAC

THAT IN

BONE GRAFTS

TO THE

FIOM

THE

CREST INSTEAD

OF HORN THC TO

RIBS

RAISED

THE

FREQUENCY ADDIUIUI ALVEOLAR

OF SUCCESSFUL

OPETATIONS

FROM

34

58

AND WITH
BUCCAL

SUBSEQUENT
SIDE OF THE

BUCAL
RIDGE

BAR THE

SPONG HONE

GRAFT ON THE

TO COVER

DEFECT

TO

98
AND OF HIP
STEIN EXPRESSED STATING

IN

1974

SCHMID

WIDMAIER

REICHERT
LAYERS

PREFERENCE

FOR COMPACT

AND SPONGY
LESS

BONE

RIB

CONSIDERED IMPLANTS ARE

USEFUL IN

BECAUSE OF THE SMALL AMOUNT OF BONE

SMALL CHILD

AND ESPECIALL

SPONGIOSA

OBTAINABLE

TESSIERS

METHOD OF

HARVESTING

ILIAC

BONE

IS

DESCRIBED

BY
TIMES

WOLFE OF MIAMI
WITHOUT

WHO HAS

USED THE METHOD MORE THAN 100

INFECTION OR CONTOUR

COMPLICATIONS
LESS

OF BLEEDING

DEFORM

IY

IRY

AND WITH

DISCOMFORT

THE

SKIN

INCISION

ABOUT
ILIAC CREST

CM LONG
PERIOSREUM

IS

MADE TA

SEVERAL

CM BELOW
CURS REFLECT

THE LONGER THE LIPS

IS

INCISION THE ILIAC

THROUGH
CIESR

OBLIQUE

OF

BEHIND THE ANTERIOR SUPERIOR SPINE

AND PERIOSREUM

REFLECTED

326

FROM INNER EXPOSE

AND OUTER SURFACES OF THE ILIUM

TESSIERS

RETRACTORS

FIT

PERFECTLY TO

THE CENTRAL BONE WHICH WILL

IF
IS

BE HARVESTED AND BOTH CORTICAL PLATES CAN BONE

IS

BE TAKEN

NEEDED

EXTRA

CANCELLOUS

TAKEN

WITH
LIPS

CURETTE

THE

SITE

GENERALLY

DRAINED

WITH

HEMOVAC AND THE

FINAL

OF THE CREST ARE

WIRED FIRMLY TOGETHER COAPRED WITH

AN
IS

HAVE BEGUN USING

SUPERIOR

WIRE TO FIGURE OFEIGHT THESE

HOLE
IS

LIPS ICE

TO THE

INTACT ANTERIOR

SPINE

MADE

IN

THE SPINE
THIS

PICKLIKE
THE HIP

INSTRUMENT
IS

WALTER LORENZ
IS

THE

BEAUTY OF

METHOD

THAT

SOID

RHETE

NO POSTOP MOVEMENT OF BROKEN WALK THE

FIRST

BONE OR TORN MUSCLE AND THE PATIENT

POST OP

CAN GENERALLY

OR SECOND

DAY

TIBIA
IN

YOUNG

INFANTS

OF PREWEIGHTBEARING
AS

AGE

MEDIAL

SLIGHTLY

CUIVED

IFLEISIUN

DESIGNED

BY JOHANSON AND OHISSON

GIVES EXCELLENT

ACTA OF THE

HIRURGICA
TIBIAL

SCANDINAVICA OFFERING

1961

EXPOSURE

SHAFT

LARGE SUPPLY
IS

50

CC OR

MORE OF CANCELLOUS
QUANTITY INTO OF THE
FREE

BONE

CORTICAL

SEGMENT

REMOVED AND

THE DESIRED

CANCELLOUS
CLEFT TO

BONE AND MARROW CAN BE TAKEN

LINE

AND PACKED

THE

OF INCISION

THE RIBIAL

CORTICAL

SEGMENT CHISELED

BE REMOVED AND THE BONE GRAFT WITH RADIOGRAPHS OF THE

GRAFT TIBIA

EXTRA THE

BONE MARROW
DEFECT

ARE

SHOWN
IJTCR

PRESENT

TWO WEEKS
BEGIN AND THE

REMOVAL OF THE

WITH PERIOSTEAL

BONE FORMATION
VISIBLE
SCARS

NING AND HEALING

POSSIBILITY

ONLY SHORT

THREE

MONTHS

LATER
THIS

OF

LEG BAVL

REDUCED

DONOR AREAS

POPO

AI IRY

VOMER
VORNER
BUT
IN

THE

PROJECTING

PREMAXILLA

HAS AN

ECONOMIC ADVANTAGE
SURGEONS
IN

OFFERS

LIMITED
IN THIS

SUPPLY

THE

CHANCE OF THE

BEING

OVERZEALOUS MUG OF THE

QUEST FOR BONE TNO FAR

MIGHT

RESULT

RERROPOSITION

PREMAXILLA

IN

INFANTS

AND CHILDREN
AGE OF

SKULL

ALSO

IS

SOURCE OF

BONE

ND
327

FOR GRAFTING

HT

LII

OF

FULL

COMPLETE

REGENERATION SKULL

OCCURS

EVEN

WHEN

ARE TAKEN

DESTINY
OF

OF

TITE

BONE GRAFTS
POSITION THE

COURSE THE VASCULARITY OF

GRAFT

AND FUNCTIONAL
ALL

OF THE

BED

THE

TYPE

AND

ITS

SIZE

INFLUENCE

DESTINY

OF THE

BONE

GRAFTS

MANCHESTER OF AUCKLAND
IN

NEW ZEALAND

STATED IN

MELBOURNE

1971
CLAIMED

MANY
AS

AND YEARS AGO

SKIN

REPEAT

TODAY

THAT

BONE

GRAFT RAKES

AND

REMAINS

JUST

GRAFT DOES

IVY

PARALLELING STATED

THE LONG LIFE IN

OF HIS BONE GRAFTS AND

IN

JUST

AS

GOOD SHAPE
SAW ONE OF
YEARS SINCE INTO
IT

MONTREAL
AT

MY

BONE GRAFTS THE OTHER DAY MAINTAIN

IT

MOUNT DORA AND

THAT

IS

48

WAS TRANSPLANTED WITH

THAT ONCE YOU GET THE BONE GRAFT WILL REMAIN THERE IN

GOOD POSITION

SUCCESSFUL RALCE

GOOD SHAPE

AND WITHOUT

CHANGE

OSS

AND

BROADWAY OF NORWICH ENGLAND

TOUR

IN

1966

MADE
UNDER THE

THREEMONTH
AUSPICES

OF EUROPEAN

BONE

GRAFTING

CENTERS

OF THE

COUNCIL

OF EUROPE

AND REPORTED
WHILE
RESORHED THE
IN

IN

MANY

OF THESE

CENTRES RHC GRAFTS SMALL

AFREI

THE
AT

ALVEOLAR THE
LEVEL

REGION
OT THE

LEANING NASAL

ONLY

STRUT OF HONE JOINING

SEGMENTS

FLOOR

THEY
INTO

THEREFORE CONSIDERED THE

GRAFT

THAT THE QUESTION OF HAVING

TEETH ERUPT

HAD

PERHAPS

BEEN OVERSRRESSED
OF FOXES LOOSE IN FLYING
HIS

THIS AND

WAS

LIKE

TURNING

PAIR

THE CHICKEN SINCE

COUP
THE

FEATHERS

AND

FUR HAVE THE YEARS

BEEN

EVER SPURS

JOHANSON
ATTACKED

FIGHTING INTRUDERS

COCK OF
SEVERAL

COOP BARED
LATER

AND

WANT TO COME HACK TO THIS

VERY IIRIRARING

REPOIR

OFJOSS

WHICH
IN

REALLY

THOUGHT WAS
COUNTRIES

ONE WHERE
ORHEIS
JUST

IT

WAS STARED THAT

MOST OF THE

HE

VISITED THE

AMONG
GRAFT

NN

UWN JINIC

LAC AT NIGHT

THE PRIMARY IN

HONE GRAFT AN

ONLA

DISAPPEAIED

HAVE NEVER USED

MY

WHOLE SERIES

ONLAY

GRAFT

AND
IT AS

STILL

LATER
CASE WHERE THE

SAID BY JOSS OR RCMAINED AS THIS

AS CRY

THAT

HE NEN

ER

SAW

BONE GRAFT HAD

SURNIVED

BONE GRAFT ALL OT THEM WERC ABSORBED HE SAID

BECAUSE IN

RHOUI 328

FUNM

OUT

SERICS

NN

HAD NEN

ER

SEEN

CASE

LIKE

THIS

WEHAVE
THIS

NEVER

DEMONSTRATED

CASE TO

HIM

SO

WE WONDERED WHERE

HE GOT

KNOWLEDGE OF

KRIENS
PROCESS THE

HAMBURG ACCEPTED
WAS
STILL

THE CHALLENGE

BUT NOTED THAT THE

DESCRIBED FIRST

OF BONE GRAFTING OF THE

BEING

IMPROVED HE
OSTEOPLASTY

EVOLUTION
STRUT

SCHUCHARDT

PRIMARY

STRONG
LATER

WAS USED TO HOLD THE ALVEOLAR

RESORPTION

SEGMENTS APART BUT

PARTIAL

OF THE GRAFT WAS SEEN AS SCHUCHARDT AND

STRUTS

KRIENS

NOTED THAT SMALL

THE GRAFT WITH

HAD

RARE

TOOTH BUD MAKING

COLLAPSE THEY

ITS

WAY

INTO

SUBSEQUENT ALVEOLAR
THE

WERE
AS

STIMULATED POSSIBLE

TO INCREASE

AMOUNT OF BONE AS MANY

THE ALVEOLAR SINCE

LAYERS

WERE INSERTED
FILLED

BETWEEN WITH

STUMPS
TRANSPLANTED

AND

THE

POCKET WAS

FURTHER

CHIPS

COSTAL

BONE

HAS

NO

INHERENT

GROWTH POTENTIAL
IN FACT

INTRUSION

OF TOOTH

GERMS
THE

WAS CONSIDERED
GRART
IN

IMPORTANT
THREE

WHERE

TOOTH BUD ENTERED OF THE BONE

ABOUT

MONTHS

RESORPTION

WAS NO

ION GER

PROBLEM KRIENS
TO STIMULATE

ENDED WITH
HONE GROWTH

PROVOCATIVE HY THE
TO THE

TEASER

THE

EFFORT

REGIONAL

TRANSPLANTATION STORY OF

OF

EPIPHYSEAL OSTEOPLASTY

CARTILAGE

MAY ADD

ANOTHER CHAPTER

PRIMARY

AT

THE

969
THE

CHICAGO
AIR

CLEFT

SYMPOSIUM

COLONEL
SERIES

HASKELL OF 125

GRUBER OF BONE

US

FORCE

REFERRED TO HIS

YOUNG

GRAFTS

WE HND THAT
THEN ITHIN

IN

PERIOD PERIOD

OF

WCEK THE
WEEKS
SALR5

HONE GI

AFT AS

SUCH DISAPPEARS

AND

OF 12

MU SUDDENLY
ARC REINUVED
IS

HEGIN

TO SEE HONE LAID

LOWN

FEEL

THAT THE ORGANIL

THIS

AND THE INORGANIC DONE

MATRIX
GREAT

REMAINS AND UPON

HASE

NEW HONE

LAID

DOWN WE HAVE
ALVEOLAR

MANY

IAY

STUDIES

OF THESE

WE

FIND

WE DONT HAVE
IS

HONE

WE
THE

HAVE MAXILLARY PRIMARY

HONE AND

OUR
THE

OLDEST CASE

NOW 4 YEARS

OF AGE AND IN

DENRIRION

HONE HAS REMAINED

MATTHEWS RESPONDED
AGREE ENTIRELY OR
THIS

WITH COLONEL GRUHER THAT THERE

THINK

THIS

HONE

IS

NOR THE HONE THAT WAS

NALLV LTHT
IS

THE ORRHOPAEDIC

SURGEONS SETTLED YEARS AGO THAT WHICH WAS PROVIDED

THE

RE

OCCURRENCE

OF HONE ON

MATRIX

IGINAL

GRAFT

IN

196

STELLMACH HAD MADE

HONE HCCORNES

SIMILAR

STATEMENT TWO

TRANSFORMED
IS

ITH

THE

FIRST

YEARS

AFTER

NE

RRUCRURE

SIMILAR

TO THE

NEIGHHORING

HONE

IN FACT

AS EARLY

AS

1961

DIOGRAPHY TO STUDY
PALATE CONTRADICTED

AUTOGENOUS

MICRORA JOHANSON AND ROCKERT USING TIBIAL AND ILIAC BONE GRAFTS TO THE
FINDINGS THAT
ALL

HOLMSTRANDS 1957
GRAFTS

EVIDENCE

FROM STUDY OF BONE

POINTED
ORIGINAL TO THE REPLACING

BONE

ASSUMING

THE

SAME

ULTRASTRUCTURE

AS THC

TRANSPLANT

OHANSON AND ROCKERT FOUND THAT THE EXCESSIVE WAS ABSORBED AND NOT REMINERALIZED
ORIGINAL ADJACENT FUNCTIONAL

TISSUE

OF THE GRAFT
ITS

THE

REST OF THE GRAFT LOST

STRUCTURE AND WAS TRANSFORMED TO THE PALATAL

SAME

STRUCTURES

AS TO

BONE SHOWING GOOD

ADAPTATION

OF THE GRAFT

DEMANDS
CONCLUDING STATEMENT DURING
REPORTED THE

AS

HIS

1969

CHICAGO

CLEFT

SYMPOSIUMJOHANSON
GRAFT

HAVING OPENED

SIXYEAROLD

BONE

THE
CASE

AREA WHERE THE

BONE GRAFT WAS LOOKED EXACTLY

AS

IF

IT

WAS

NON

CLEFRED

COLONEL
GRAFTING

GRUBER THEN ASKED JOHANSON WHY HE

ORTHODONTICS

ADVISED

BONE

AFTER

AND WHETHER
RESULTING

IT

HAD BEEN

SUCCESSFUL

WITH
ARCH

THE

PERMANENT

DENTITION

IN

GOOD

OCCLUSION

AND

ALIGNMENT
THAT

JOHANSON ANSWERED
HAS FINISHED
AT HIS
XX

WE FEEL

HEN THE ORTHODONTIST

THAT YOU DO NOT OF

ORK AND

WE ADD BONE MORE FROM

TO THE ALVEOLUS

HAXE TO LOOK

THESE CASES ANX

PROSTHODONRIC POINT

VIEW

TOM
GRAFTING

CRONIN
STATISTICS

OF

HOUSTON

HAVING

GIVEN

SOME OF

HIS

BONE

SUGGESTED THAT THE METHOD OF GRAFTING

MUST BE

IMPORTANT

WHEN WE JUST
BONE
LEFT

PUT IN

THE

ONLAY

GRAFT IN

WE

OFTEN

SEEMED TO HAVE VERY

IN

LITTLE

LATER

BUT BY PURRING
FAIRLY

MORE BONE

WEDGE

GRAFTS

THE

GRAFTS

SEEMED TO REMAIN

WELL AS

SHOWN BY

REPEATED

XRAYS OVER SEVERAL YEARS

DAVID

MATTHEWS OF LONDON BACKED CRONIN

IS

MY

BONE

GRAFT

ONLY

PUT INTO

THE

ALVEOLAR

GAP

IT

IS

INDEED
THE

STRUT OR

WEDGE WOULD
THINK

FOUND IN
IT

315

OF CASES TEETH FOR DENTAL

IT

GROWING INTO
TO

GAP
STATIC

IMPOSSIBLE

FOLLICLE

GROW

INTO

JUT

WELL ESTABLISHED

BONE PLATE OU PICTUIES

BUT

CAN

AND DOES GROW INTO GLOWING

INTO

THIS THE

NE

BONE

AND

CAN

SHOXX

OF THE

TEETH

BONE

330

BIOLOGY FACTORS
WOLFE
DISCUSSED THE

BONE GRAFTS AND INFLUENCING THE SURVIVAL

OF
CRANIOFACIAL

SURGEON

AT

THE

UNIVERSITY

OF

MIAMI

BIOLOGY

OF BONE GRAFTS
THERE
IS

TRANSPLANTED BONE SURVIVES

NO DOUBT OF

THIS

TO ANYONE

WHO HAS
PUT
STILL

HAD THE OPPORTUNITY TO REOPERATE IN AN AREA IN WHICH BONE GRAFT

HE HAS PREVIOUSLY
IS

WHETHER
IT
IS

OR NOT THIS LIKELY THAT

IS

THE

SAME BONE THAT WAS PUT IN

THE INDIVIDUAL CANCELLOUS

MATTER OF DEBATE
OSTEOGENIC

SOME OF

CELLS

WITH

POTENTIAL THE

DO SURVIVE

BOYCE
AS IN

BUT

IT

IS

ALSO EVIDENT OR BOILED CELLS

THAT

ONE CAN

PUT

IN

ONLY

MINERAL

MATRIX

FREEZEDRIED

BONE AND

EVENTUALLY THERE
IS

HAVE INVASION

AND INHABITATION

BY OS TEOCYTIC
IN SKIN

AND

JUST

AS
IS

CONSTANT

TURNOVER OF CELLS AND COLLAGEN AND HAS CONSTANT

GRAFT

BONE GRAFT

METABOLICALLY

ACTIVE

CELLULAR AND MATRIX

TURNOVER
CANCELLOUS

GOOD
BONE TO

BIT OF WORKREMAINS TO BE DONE WITH RADIOISOTOPELABELLED

CLARIFY

EXACTLY

WHAT

IS

HAPPENING

FACTO

IMPORTANT THE

TO

MAXIMAL OF BONE

SURVIVAL

OF THE BONE GRAFT

FIRST PERSISTENCE CANCELLOUS BE EXPECTED OF

IT IS

TYPE

USED

THERE

IS

HIGHER PERCENTAGE

OF

TAKE

OF THE VOLUME OF THE TRANSPLANT WITH GRAFTS WHICH

AS

ARE LARGELY GRAFT CAN

OPPOSED TO CORTICAL
IN

THUS

HIGHER PORTION
RIB

OF AN

ILIAC

TO SURVIVE

COMPARISON WITH

GRAFT

SINCE

LARGER PORTION

CANCELLOUS GRAFT MUST BESOLIALY TO MOTION

AT

THE BONE
THAT ARE SUBJECT

AFFIXED POINT

TO THE RECIPIENT
XS

BON
ICCIPIENT

AREA

GIAFTS

THEIR

OF CONTACT

ITH

AREA BONE SPLIT IIBS IN

SEEM TO

FARE

WORSE THAN ONES WHICH

AREA DO BETTER
LAID IF

ARE SOLIDLY

WIRED IN PLACE
RAL

THE INFRAORBIRAL THOSE WHICH

IRED

TO THE INFRAORBI

IM
ALLOV

COMPARED TO

ARE JUST

IN PLACE NASAL BONE GRAFTS WHICH WILL HAVE TO BE REDONE THERE

IF
IS

SOME WIGGLE

ARE OFTEN THE ONES WHICH EVIDENCE SURFACE THAT SPLIT

RIBS

SOME EXPERIMENTAL
IS

DO BETTER

LAYER OF PERIOSTEUM

LEFT

ON THE OUTER

BUT

THEN THE
AGAINST

DONOR AREA WILL NOT DO SO ABRADED DONOR BONE THAN

IF

WELL

AND THE CANCELLOUS

IS

SURFACE PLACED

ANY OTHER COMBINATION

USED THERE SHOULD BE

THEN COVER COVERAGE OF BONE GRAFTS BY PERIOSREUM IF POSSIBLE

AND
IF

BY ADEQUATE AMOUNTS OF SOFT TISSUE

FREE IN SOFT TISSUE

NOT UNDER GREAT TENSION

BONE GRAFTS ARE PLACED

ANTICIPATED PRESSURE

ALMOST COMPLETE RESORPTION

IF

CAN BE
TO

CONSIDERABLE

RESORPTION

ALSO OCCURS

BONE GRAFTS ARE SUBJECT

FROM RIGHT
SIZE

INADEQUATE

SOFT TISSUE BODIES

COVER
PRESENT

THE
IT

AND NUMBER OF FOREIGN

SKILL IN

SHOULD BE MINIMIZED
TO OBTAIN SOLID FIXATION PLATES

MA
ITHOTIT

TAKE

MOLE

CARPENTRY

AND INGENUITY

THE USE OF SCREWS

MESH

TRAYS AND CUMBERSOME ORTHOPEDIC

HUT RHESC

RNPES OF HARDWARE INTERFERE

XITH

VASCULAR

CONTACT

WITH

THE GRAFT

331

PROVIDE

NIDUS FOR INFECTION BE OBTAINED

AND ARE AGAINST WITH

BASIC

PRINCIPLES

SOLID

FIXATION

CAN GENERALLY AUTORETENTIVE

EXRRINSIC

FEW PROPERLY AND OCCASIONALLY

PLACED SMALL BETTER

WIRES

INTERLOCKING IF

BONE FIXATION

KIRSCHNER WIRE

SUPPORT AND FIXATION NORMAL

IS

REQUIRED

IT

IS

TO USE

FEW PERCUTA AND THEN

NEOUS SCREWS IN
BRIDGE

BONE ON EITHER WITH

ACRYLIC

SIDE

OF THE BONE

GRAFT

ACROSS EXTERNALLY FINALLY IN

HUMAN BEINGS
AUROGENOUS

THERE SEEMS TO BE

CRITICAL

MASS

OF BONE

GRAFT

EVEN FRESH

CANCELLOUS THAT CAN BE EXPECTED BONE GRAFT CAN EXCEED ONE

THIS

TO SURVIVE

UNDER THE BEST OF CIRCUMSTANCES DIMENSIONS

SURGERY

CM

ON TWO

BUT NOR THREE IF LARGER AMOUNTS OF BONE THAN BE STAGED

ARE REQUIRED

MUST

THE

DIFFICULTY

OBTAINING

AND THE PAIN ADEQUATE AMOUNTS OF DONOR BONE WITH

TO FIND TAKING

AND DEFORMITY OFTEN

ASSOCIATED YEARS

BONE

IN

THE

PAST HAVE LED TO

SUBSTITUTE THE

MANY

EFFORTS

OVER

THE

AN

ACCEPTABLE

BONE

EVOLUTION MATERIALS

HAS BEEN FROM IVORY

TO KID
SILASRIC

BONE TO BANK BONE AMONG BIOLOGICAL

TO PROPLAST

AND FROM ACRYLIC TO

AMONG
ALL

SYNTHETIC OF THESE

MATERIALS

CERTAINLY

THERE HAVE BEEN REPORTED

IS STILL

SUCCESSES USING

SUBSTANCES

BUT THE FAILURE RATE

PATIENT

AND THE HIGH COMPARED TO FRESH AUROGENOUS BONE

AT IISK

CONTINUES TO BE
AT

FROM INFECTION

AND IEJCCRION

LONG AFTER THE INCORPO NORMAL

PROCEDURE
RATED INTO

TIME WHEN THE AUROGENNUS

SKELETON

BC WOULD HAVE BEEN

DEFENSE

THE

AND HAVE THE

SAME

MECHANISMS

AS

BONE
UNTIL WILL THE BASIC TRANSPLANTATION BARRIERS AIE

ELIMINATED

AS

THEY EVENTUALLY
XX

HE

EFFOIRS

SHOULD CERRAINL

CON TINUE
AS LITTLE

IN

DCX ELOPING DITHCULR

AND PERFECTING

OF RAKING
POSSIBLE

WITH AUROGENOUS BONE

AND DEFORMIR

AS

332