Date post: | 16-Apr-2017 |
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Bone GraftingDr. Hitendra Patil
Department of OrthopaedicsESIPGIMSR MGM HOSPITAL
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 1. Autograft
− Bone harvested from the patient’s own body
2. Allograft − Cadaveric bone (usually obtained from a
bone bank)3. Synthetic
− Often made of hydroxyapatite or other naturally-occurring and biocompatible substances with similar mechanical properties to bone.
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
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)
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–Provision of scaffold for formation
of new bone
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
Incorporation of graftPrimary phase-–Hemorrhage– Inflammation –Accumulation of haemopoietic cells
including neutrophills, macrophages and osteoclasts
–Removal of necrotic bone
–Osteoconductive factors released from graft during resorption and cytokines released during inflammation
–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
Host response to cancellus bonegraft differs from cortical
– In cortical bone graft first osteoclastic resoption then ostioblastic activity
–Where as in cancellous bone graft bone formation and resorption occurs simultaneously called creeping substitution
– Therefore cancellous bone graft incorporates quickly
–But does not provides immediate structural support
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