Bone grafting

Dr. Hitendra Patil registrar

1. Bone Grafting Dr. Hitendra Patil Department of Orthopaedics ESIPGIMSR MGM HOSPITAL

2. 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 conditions to fasten the bone healing

3.  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.

4. Classification Origin: Autogenous Allogenous Blood supply : Nonvascularised Vascularised Type of bone : Cortical Cancellous Corticocancellous

5. Indications

6. Indications To promote union or fill defects in Fresh fractures Delayed union Malunion Osteotomies

7. Indications To fill cavities/defects resulting from cysts, tumors etc

8. Indications To bridge joints and provide arthrodesis

9. Sites of Aoutogenous bone graft Cortical Fibula ,Rib Cancellous Iliac crest,Proximal Tibia,Radius Corticocancellous Iliac crest

10. Essential properties of bone graft

11. Essential properties of bone graft Osteogenesis Synthesis of new bone from the cells derived from graft and host

12. Essential properties of bone graft Osteogenesis Synthesis of new bone from cells derived from graft and host Osteoinduction Stimulation of synthesis Growth factor is responsible (BMP)

13. Essential properties of bone graft Osteogenesis Synthesis of new bone from cells derived from graft and host Osteoinduction Stimulation of synthesis Growth factor is responsible (BMP) Osteoconduction Provision of scaffold for formation of new bone

14. Autogenous grafts Ideal as a bone graft As possesses all characteristics necessary for new bone growth Osteoconductivity Osteogenicity Osteoinductivity .

15. Include Cancellous Vascularized cortical Nonvascularized cortical Autologous bone marrow grafts

16. 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.

17. Allogenic Grafts Obtained from a person other than the patient. Advantage – No donor site morbidity Large amount can be used

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. Incorporation of graft Primary phase- Hemorrhage Inflammation Accumulation of haemopoietic cells including neutrophills , macrophages and osteoclasts Removal of necrotic bone

28. 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

29. 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

30. 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

31. Fracture shaft of Radius and Ulna with segmental bone loss

32. Tricortical illiac crest graft for shaft of radius Nonvacularised fibula graft for ulna

33. Thank You