bone grafting in orthopedic
TRANSCRIPT
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Bone GraftingDr. Amr Mansour
Orthopedic surgeon
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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
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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.
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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
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ClassificationOrigin:
−Autogenous−Allogenous
Blood supply:−Nonvascularised−Vascularised
Type of bone :−Cortical −Cancellous −Corticocancellous
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Indications
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IndicationsTo promote union
or fill defects in –Fresh fractures–Delayed union –Malunion–Osteotomies
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IndicationsTo fill
cavities/defects resulting from cysts, tumors etc
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IndicationsTo bridge joints and provide
arthrodesis
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Sites of Aoutogenous bone graft
Cortical – Fibula ,Rib
Cancellous – Iliac crest,Proximal Tibia,Radius
Corticocancellous – Iliac crest
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Essential properties of bone graft
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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
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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
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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
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Autogenous graftsIdeal as a bone graft –As possesses all characteristics
necessary for new bone growth
−Osteoconductivity−Osteogenicity−Osteoinductivity.
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Include –Cancellous–Vascularized cortical–Nonvascularized cortical–Autologous bone marrow grafts
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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.
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Allogenic Grafts Obtained from a person other than
the patient.Advantage ––No donor site morbidity– Large amount can be used
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Risk and complications Disease transmission , like HIV
Hepatitis c and B
Wound drainage with calcium sulphate
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Incorporation of graftPrimary phase-– Inflammation
–Accumulation of haemopoietic cells including neutrophills, macrophages and osteoclasts
–Removal of necrotic bone
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–Osteoconductive factors released from graft during resorption
–Recruitment and stimulation of mesenchymal stem cells to osteogenic cells
–Active bone formation
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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
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Fracture shaft of Radius and Ulna with segmental bone loss
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Tricortical illiac crest graft for shaft of radius
Nonvacularised fibula graft for ulna
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Thank You