Bone GraftingDr. Amr Mansour

Orthopedic surgeon

Introduction Bone grafting is a surgical procedure

done in order to fill the defects in cortical and cancellous bones formed secondary to – Trauma– Tumor– Infections and other conditionsto fasten the bone healing

 Bone grafts may be Autograft

− Bone harvested from the patient’s own body

Allograft − Cadaveric bone (usually obtained from a

bone bank)Synthetic

− Often made of hydroxyapatite or other naturally-occurring and biocompatible substances with similar mechanical properties to bone.

Demineralized bone matrix − Acidic extraction of bone matrix from

allograft removes the minerals and leaves the collagenous and noncollagenous structure and proteins

Reamer Aspirator Irrigator− Provides large volume of bone graft

from intramedullary sourcestem cellsXenograft from animals

ClassificationOrigin:

−Autogenous−Allogenous

Blood supply:−Nonvascularised−Vascularised

Type of bone :−Cortical −Cancellous −Corticocancellous

Indications

IndicationsTo promote union

or fill defects in –Fresh fractures–Delayed union –Malunion–Osteotomies

IndicationsTo fill

cavities/defects resulting from cysts, tumors etc

IndicationsTo bridge joints and provide

arthrodesis

Sites of Aoutogenous bone graft

Cortical – Fibula ,Rib

Cancellous – Iliac crest,Proximal Tibia,Radius

Corticocancellous – Iliac crest

Essential properties of bone graft

Essential properties of bone graft

Osteogenesis–Synthesis of new bone from the cells derived from graft and host

including primitive mesenchymal stem cells, osteoblasts, and

osteocytes 

Essential properties of bone graft

Osteogenesis–Synthesis of new bone from cells

derived from graft and hostOsteoinduction–Stimulation of synthesis , factors

that stimulate bone growth–Growth factor is responsible (BMP)

Bone morphogenic protein

Essential properties of bone graft

Osteogenesis–Synthesis of new bone from cells

derived from graft and hostOsteoinduction–Stimulation of synthesis–Growth factor is responsible (BMP)

Osteoconduction–material acts as a structural

framework for bone growth

Autogenous graftsIdeal as a bone graft –As possesses all characteristics

necessary for new bone growth

−Osteoconductivity−Osteogenicity−Osteoinductivity.

Include –Cancellous–Vascularized cortical–Nonvascularized cortical–Autologous bone marrow grafts

Disadvantage–Donor site morbidity

−i.e.harvesting autograft requires an additional surgery at the donor site which has its own complications- inflammation, infection, and chronic pain .

–Quantities of bone tissue that can be harvested are also limited.

Allogenic Grafts Obtained from a person other than

the patient.Advantage ––No donor site morbidity– Large amount can be used

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Properties of Autografts and Allografts Bone graft

Structural strength

Osteo-conducton

Osteo-induction

Osteo -genesis

Autograft

Cancellous No +++ +++ +++

Cortical +++ ++ ++ ++

Allograft

Cancellous

No ++ + No

Cortical +++ + No No

Risk and complications Disease transmission , like HIV

Hepatitis c and B

Wound drainage with calcium sulphate

Incorporation of graftPrimary phase-– Inflammation

–Accumulation of haemopoietic cells including neutrophills, macrophages and osteoclasts

–Removal of necrotic bone

–Osteoconductive factors released from graft during resorption

–Recruitment and stimulation of mesenchymal stem cells to osteogenic cells

–Active bone formation

Second phase–Osteoblasts lines dead trabecule and

lay down osteoid–Haemopoietic marrow cells forms new

marrow in transplanted bone–Remodeling i.e. woven bone slowly

being transformed into lamellar bone by coordinated activities of osteoblasts and osteoclasts

– Incorporation of graft

Fracture shaft of Radius and Ulna with segmental bone loss

Tricortical illiac crest graft for shaft of radius

Nonvacularised fibula graft for ulna

Thank You