Bone graft

Introduction
• Bone grafting is the surgical procedure in which new bone (bone graft)
or a replacement material (graft substitute), is placed into bone
fractures or bone defects to aid in healing
• bone grafting is defined as a material that is intended to fill, augment
or reconstruct the bony defects
Types
1. based on the donor origin - autograft - allograft – xenograft
2. based on composition -cortical -cancellous -osteochondral
3. Blood supply: Non-vascularised - Vascularised
4. Preservation - fresh - frozen - freeze dried - demineralized
5. based on anatomical features - epiphyseal -metaphyseal –diaphyseal

SITES OF AOUTOGENOUS BONE GRAFT

Cortical: fibula,rib
Caancellous :Iliac crest, proximal tibia, radius
Corticocancellous: Iliac crest
BIOLOGICAL CONCEPT OF USING BONE GRAFTS
• There are three ways in which a bone graft can help repair a defect
• The first is called osteogenesis , the formation of new bone by the cells contained within
the graft.
• second is osteoinduction , a chemical process in which molecules contained within the
graft (BMP) convert the patient's cells into cells that are capable of forming bone.
• third is osteoconduction , a physical effect by which the matrix of the graft forms a scaffold
on which cells in the recipient are able to form new bone

indications
• To promote union as in - Fresh fractures - Delayed union - Malunion - Osteotomies
• To bridge joints and thereby provide arthrodesis. To bridge major defects or establish the
continuity of a long bone.
• To fill cavities/defects secondary to - Trauma - Tumor - Infections and other conditions
• Used to help fusion b/w vertebrae, correct deformities or provide structural support for
fractures of the spine.
• To repair defects in bone caused by congenital disorders, traumatic injury, or surgery for
bone cancer.
• Also used for facial or cranial reconstruction
procedure
• To place the graft, the surgeon makes an incision in the skin over the
bone defect and shapes the bone graft or replacement material to fit into
the defect.
• After the graft is placed into the defect, it is held in place with pins,
plates, or screws.
• The incision is closed with stitches and a splint or cast is used to prevent
movement of the bones while healing
• bone grafts are successful in helping the bone defect to heal. The extent
of recovery will depend on the size of the defect and the condition of the
bone surrounding the graft at the time of surgery
• A variety of natural and synthetic replacement materials are also used
instead of bone, including collagen (the protein substance of the white
fibers of the skin, bone, and connective tissues); polymers, such as
silicone and some acrylics; hydroxyapatite; calcium sulfate; and ceramics