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Bone grafting

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A tutorial class during my stint as Professor and Head ,Dept Of Orthopedics , Melaka Manipal Medical College Melaka Malaysia

A tutorial class during my stint as Professor and Head ,Dept Of Orthopedics , Melaka Manipal Medical College Melaka Malaysia

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    Bone grafting Bone grafting Presentation Transcript

    • BONE GRAFTING Prof G.S.Patnaik M.B,B.S. M.S.Ortho FAOI(USA) Professor/Orthopedic surgery
      • Bone grafting is used to repair bone fractures that are extremely complex, pose a significant risk to the patient, or fail to heal properly.
      • Bone graft is also used to help fusion between vertebrae,
    • Contd….
      • correct deformities, or
      • provide structural support for fractures of the spine.
      • In addition to fracture repair , bone graft is used to repair defects in bone caused by birth defects , traumatic injury, or surgery for bone cancer
      • Bone grafting is a surgical procedure that replaces missing bone with
      • material from the patient's own body,
      • an artificial, synthetic, or natural substitute.
      • There are three ways in which a bone graft can help repair a defect.
      • The first is called osteogenesis , the formation of new bone by the cells contained within the graft.
      • The second is osteoinduction , a chemical process in which molecules contained within the graft (bone morphogenetic proteins) convert the patient's cells into cells that are capable of forming bone.
      • The third is osteoconduction , a physical effect by which the matrix of the graft forms a scaffold on which cells in the recipient are able to form new bone
      • Autogenous Bone Grafting :Autogenous bone grafting involves taking the patient's own bone from a part of the body where it is not essential (typically from the pelvis or iliac crest), and placing it where it's needed.
      • Autogenous bone grafts are the most preferred by surgeons because there is less risk of the bone being rejected due to the fact that the bone originated in the patient's body
      • New bone for grafting can be obtained from other bones in the patient's own body (e.g., hip bones or ribs), called Autograft,
      • from bone taken from other people that is frozen and stored in tissue banks, called A llograft.
      • A variety of natural and synthetic replacement materials are also used instead of bone, including collagen (the protein substance of the white fibers of the skin, bone, and connective tissues); polymers, such as silicone and some acrylics; hydroxyapatite; calcium sulfate; and ceramics.
      • A new material, called resorbable polymeric grafts, is also being studied. These resorbable grafts provide a structure for new bone to grow on; the grafts then slowly dissolve, leaving only the new bone behind .
    • HOW?
      • To place the graft, the surgeon makes an incision in the skin over the bone defect and shapes the bone graft or replacement material to fit into the defect.
      • After the graft is placed into the defect, it is held in place with pins, plates, or screws.
      • The incision is closed with stitches and a splint or cast is used to prevent movement of the bones while healing
    • HOW??
      • Most bone grafts are successful in helping the bone defect to heal. The extent of recovery will depend on the size of the defect and the condition of the bone surrounding the graft at the time of surgery
      • Severe defects may take some time to heal and may require further attention after the initial graft. In one study of over 1,000 patients who received very large allografts after surgery for bone cancer, researchers found that approximately 85% of the patients were able to return to work or normal physical activities without using crutches
      • However, about 25% of these patients required a second operation, because the first did not heal properly. Less severe bone defects, though, should heal completely without serious complications
    • Complications
      • As with any procedure, there are risks involved; among these include reactions to medicine and problems breathing, bleeding , and infection .
      • Infection is reported to occur in less than 1% of cases and is curable with antibiotics.
      • Overall, patients with a preexisting illness are at a higher risk of getting an infection as opposed to those who are overall healthy.
    • RISKS
      • The drawbacks of Autografts include:
      • the additional surgical and anesthesia time (typically 30 minutes per procedure) to obtain, or harvest, the bone for grafting
      • added costs of the additional surgery
      • pain and infection that might occur at the site from which the graft is taken
      • and the relatively small amount of bone that is available for grafting.
    • Risks of ALLOGRAFT
      • The drawbacks of allografts include:
      • variability between lots, since the bone is harvested from a variety of donors;
      • the bone may take longer to incorporate with the host bone than an autograft would;
      • the graft may be less effective than an autograft; and
      • the possibility of transferring diseases to the patient
      • Other complications may result from the immune response mounted by the patient's immune system against the grafted bone tissue.
      • With the use anti-rejection agents (drugs to combat rejection of grafted bone tissue) immune rejection is less of a problem
    • Some definitions
      • Allograft
        • Tissue for transplantation that is taken from another person.
      • Autograft
        • Tissue for transplantation that is taken from the patient.
      • Hydroxyapatite
        • A calcium phosphate complex that is the primary mineral component of bone.
      • Osteoblasts
        • Bone cells that build new bone tissue.
      • Osteoclasts
        • Bone cells that break down and remove bone tissue.
      • Osteoconduction
        • Provision of a scaffold for the growth of new bone.
      • Osteocytes
        • Bone cells that maintain bone tissue.
      • Osteogenesis
        • Growth of new bone.
      • Osteoinduction
        • Acceleration of new bone formation by chemical means
    • THANKS