BONE GRAFT

The treatment of posttraumatic skeletal conditions

such as delayed unions, nonunions, malunions, and
other problems of bone loss is challenging.
In most cases, restoration of alignment and stable
fixation of the bone is all that is necessary to
achieve a successful reconstruction.
Sometimes, adjunctive measures such as bone-
grafting or bone transport are required to stimulate
bone-healing and fill bone defects

BIOLOGICAL CONCEPT OF GRAFTS
the biology of each of these grafts varies and may
provide one or several essential components:
1. an osteoconductive matrix, which is a scaffold or trellis
that supports the ingrowth of new bone
2. osteoinductive proteins, which stimulate and support
mitogenesis of undifferentiated perivascular cells to
form osteoprogenitor cells
3. osteogenic cells (osteoblasts or osteoblast precursors),
which are capable of forming bone if placed into the
proper environment.

The surgeons choice of the proper graft must be based on what is
required from the graft (structural or bone-forming function, or both),
the availability of the graft, the recipient bed, and the cost.

BONE GRAFT AND BONE GRAFT
SUBSTITUTES
The orthopaedic surgeon currently has several
options:
autologous or allogeneic cancellous or cortical
bone
demineralized bone matrix
calcium phosphate-based
bone-graft substitute
autologous bone marrow
Recombinant bone morphogenetic proteins or
growth factors


AUTOLOGOUS BONE GRAFT
Autologous bone grafts have osteogenic,
osteoconductive, and osteoinductive properties.

Available autologous bone grafts include
Cancellous, vascularized cortical, nonvascularized
cortical, and autologous bone marrow grafts



Advantages:
The advantages of autologous cancellous or
cortical bone grafts are their excellent success rate,
low risk of transmitting disease, and
histocompatibility.
Disadvantages:
Limited Quantity.
High Rate of Complication :
Rate of major complications of 8.6%
Rate of minor complications of 20.6%



BONE MARROW GRAFT
Injections of autologous bone marrow provide a
graft that is osteogenic and potentially
osteoinductive through cytokines and growth
factors secreted by the transplanted cells.
Bone marrow can be aspirated from he posterior
iliac wing in volumes of 100 to 150 mL and can be
injected into a fracture or nonunion site to stimulate
healing.

ALLOGRAFT
Allogeneic bone, with variable biologic
properties, is availablem in many
preparations:
demineralized bone matrix,
Morselized and cancellous chips
corticocancellous and cortical grafts,
osteochondral and whole-bone segments.

DEMINERALIZED BONE MATRIX

Demineralized bone matrix acts as an
osteoconductive, and possibly as an
osteoinductive, material.
does not offer structural support, but it is well suited
for filling bone defects and cavities. Demineralized
bone matrix revascularizes quickly.
suitable carrier for autologous bone marrow

PREPARATION
Demineralized bone matrix is prepared by a
standardized process, as originally described by
Urist et al and modified by Reddi and Huggins
allogeneic bone is crushed or pulverized to a
consistent particle size (74 to 420 m) followed by
demineralization in 0.5N HCL mEq/g for three hours.
The resi dual acid is eliminated by rinsing in sterile
water, ethanol, and ethyl ether.

BIOLOGICAL CONCEPT AND DBM TYPE
presumably attributable to proteins and various
growth factors present in the extracellular matrix
and made available to the host environment by the
demineralization process.
OSTEOCHONDRAL AND CORTICAL
ALLOGRAFTS

Osteochondral and cortical allografts are harvested
from various regions of the skeleton, such as the
pelvis, ribs, femur,tibia, and fibula, for reconstruction
after major bone or joint loss.
The grafts are available as whole-bone or joint
segments (i.e., as the whole or part of the tibia,
humerus, femur, talus, acetabulum, ilium, or hemi
pelvis) for limb salvage procedures or as cortical
struts to buttress existing bone, to stabilize and
reconstitute cortical bone after periprosthetic
fractures, and to fill bone defects.

These grafts are osteoconductive and provide
immediate structural support. They are preserved by
either deep-freezing or freeze-drying.

Fresh allografts that require no preservation are
available, but they incite an intense immune
reaction, making them less attractive than
autografts. These fresh allografts have limited
applications and are currently being used mainly
for joint resurfacing

GRAFT SUBSTITUTE
Ceramic and Ceramic composites:
Calcium based bone graft substitute












coralline hydroxyapatite grafting of the metaphyseal
defect

Bioactive glass :
composed of silica (45%), calcium oxide (24.5%),
disodium oxide (24.5%), and pyrophosphate (6%).
When implanted, they bind to collagen, growth
factors, and fibrin to form a porous matrix to allow
infiltration of osteogenic cells. The matrix provides
some compressive strength, but it does not provide
structural support.