Bone grafting is a surgical
procedure that places new
bone or a replacement
material into spaces
between or around broken
bone (fractures) or in holes
in bone (defects) to aid in
Bone grafting is used to repair bone fractures that
are extremely complex, pose a significant risk to the
patient, or fail to heal properly.
Used to help fusion between vertebrae, correct
deformities, or provide structural support for
fractures of the spine.
To repair defects in bone caused by congenital
disorders, traumatic injury, or surgery for bone
Bone grafts are also used for facial or cranial
MAJOR FUNCTIONS OF GRAFT
Osteogenesis, the formation of new bone by the
cells contained within the graft.
Osteoinduction, a chemical process in which
molecules contained within the graft (bone
morphogenetic proteins, abbreviated as BMP)
converts undifferentiated mesenchymal cells
into cells capable of forming bone.
Osteoconduction, a physical effect whereby the
graft matrix configures a scaffold on which ,cells
in the recipient form new bone.
SOURCES OF GRAFT
Autograft-gold standard bone grafting technique
A graft made of bone from the patient's own
body is an autograft.
Usually taken from tibia,fibula or iliac crest to
provide cortical,whole bone transplant and
cancellous bone respectively.
Iliac crests are the commonest site for takng
Major disadvantages are limited supply and
donor site morbidity
Ambulation is delayed until the defect is partially
pain and infection at the site from which the
graft is taken
Vascularized grafts - sophisticated microsurgical
techniques are necessary&in major sites of
loading , osseous hypertrophy may occur
Allograft is harvested from an individual
other than the one receiving the graft.
Allografts are used because of the inadequate
amount of available autograft material, and
the limited size and shape of a person's own
Usually taken from cadavers; it is typically
sourced from a bone bank.
Using allograft tissue from another person
eliminates the need for a second operation to
remove autograft bone or tendon.
It also reduces the risk of infection, and
safeguards against temporary pain and loss
of function at or near the secondary site.
Bone variability because it is harvested from a
variety of donors.
Grafted bone may take longer to incorporate
with the host bone and may be less effective
than an autograft.
Possibility of transferring diseases to the
Potential immune response complications
(patient's immune system fighting against the
grafted bone tissue). This problem is lessened
through the use of anti-rejection drugs.
There are three types of bone allograft
Fresh or fresh-frozen bone
Freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone allograft
Xenograft bone substitute has its origin from
a species other than human, such as bovine.
Xenografts are usually only distributed as a
Artificial bone can be created from ceramic
such as calcium phosphates (e.g.
hydroxyapatite and tricalcium phosphate),
Bioglass and calcium sulphate; all of which
are biologically active to different degrees
depending on solubility in the physiological
These materials can be doped with
growth factors, ions such as strontium or
mixed with bone marrow aspirate to increase
The presence of elements such as strontium
can result in higher bone mineral density and
enhanced osteoblast proliferation in vivo.
Alloplastic grafts may be made from
hydroxylapatite, a naturally occurring mineral
that is also the main mineral component of
bone. They may be made from bioactive glass
calcium carbonate:unpopular ;completely
resorbable in short time which make the bone
easy to break again
The surgeon does a clinical examination, and
conducts tests to determine the necessity of
a bone graft,to determine the precise
location of damage,exact amount of damage.
These tests include x rays,
magnetic resonance imaging (MRI), and
computed tomography (CT) scan.
thorough physician consult before surgery
Arrange for blood in case a transfusion is needed
Proper nutrition to achieve good nutritional status
before and after surgery
following a recommended exercise program before
and after surgery.
maintaining a positive attitude
Single onlay cortical graft: was
mainly used for ununited
diaphyseal fractures , used
for a limited group of fresh,
malunited and ununited fractures.
Dual onlay grafts: used in treating difficult
and unusual nonunions or for the bridging of
A slot or rectangular defect is created in the
cortex of the host bone. unpopular:
occasionally used in arthrodesis particularly
Used in nonunion of the medial malleolus,
small bones of the hand, wrist or foot.
5)Medullary Grafts:was used previously for
6)Osteoperiosteal grafts:not used
Multiple Cancellous Chip grafts:
Particularly used for filling cavities or defects
resulting from cysts, tumors or other causes.
Also used in arthrodesis of the spine as
osteogenesis is the primary concern
used for the obliterating large defects of tibia
and femur.A large hemicylindrical cortical graft
from affected bone is placed across the defect
and is supplimented by cancellous iliac bone.
Whole bone Transplant:Greater use is in the
treatment of defects of long bones produced
by massive resection for bone tumors.
It is the most practical graft for bridging long
defects in diaphyseal portion of bones of
Risks for grafts from the
acquired bowel herniation (this becomes a risk for
larger donor sites (>4 cm)).
meralgia paresthetica (injury to the lateral femoral
cutaneous nerve also called Bernhardt-Roth's
fracture (extremely rare and usually with other
injury to the cluneal nerves (this will cause
posterior pelvic pain which is worsened by
injury to the ilioinguinal nerve
minor hematoma (a common occurrence)
deep hematoma requiring surgical intervention
pseudoaneurysm of iliac artery (rare)
cosmetic defects (chiefly caused by not
preserving the superior pelvic brim)
Most bone grafts are successful in helping the
bone defect to heal.
The extent of recovery depends on the size of
the defect and the condition of the bone
surrounding the graft at the time of surgery.
Severe defects take some time to heal, and may
require further attention after the initial graft.
Less severe bone defects heal completely
without serious complications.
Repeat surgery is sometimes required if the
condition recurs or complications develop.