Bone grafting1

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Bone grafting1

  1. 1. DEFINITION  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 healing.
  2. 2. USES 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 cancer. Bone grafts are also used for facial or cranial reconstruction
  3. 3. MAJOR FUNCTIONS OF GRAFT MATERIAL  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.
  4. 4. CLASSIFICATION Donor origin autograft allograft xenograft Composition cortical cancellous osteochondral Preservation fresh frozen freeze dried demineralized
  5. 5. 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 bone grafts
  6. 6. Disadvantages  Major disadvantages are limited supply and donor site morbidity  Ambulation is delayed until the defect is partially healed  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
  7. 7. Allograft  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 bone.  Usually taken from cadavers; it is typically sourced from a bone bank.
  8. 8. Advantage  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.
  9. 9. Drawbacks…..  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 patient(viral transmissions).  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.
  10. 10.  There are three types of bone allograft available:  Fresh or fresh-frozen bone  Freeze-dried bone allograft (FDBA)  Demineralized freeze-dried bone allograft (DFDBA)
  11. 11. Xenografts/Heterogeneous Grafts  Xenograft bone substitute has its origin from a species other than human, such as bovine. Xenografts are usually only distributed as a calcified matrix.  Result-unsatisfactory
  12. 12. Synthetic variants 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 environment.
  13. 13.  ] These materials can be doped with growth factors, ions such as strontium or mixed with bone marrow aspirate to increase biological activity.  The presence of elements such as strontium can result in higher bone mineral density and enhanced osteoblast proliferation in vivo.
  14. 14. Alloplastic grafts  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
  15. 15. Osteoconductive Osteoinductive Osteogenic Alloplast + - - Xenograft + - - Allograft + +/- - Autograft + + +
  16. 16. Diagnosis/Preparation  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.
  17. 17. 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 smoking cessation
  18. 18. Various techniques  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 massive defects.
  19. 19. Inlay Grafts:  A slot or rectangular defect is created in the cortex of the host bone. unpopular: occasionally used in arthrodesis particularly at ankle.
  20. 20.  4)Peg Grafts  Used in nonunion of the medial malleolus, small bones of the hand, wrist or foot.  5)Medullary Grafts:was used previously for diaphyseal fractures.  6)Osteoperiosteal grafts:not used
  21. 21.  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  Hemicylindrical Grafts:  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.
  22. 22.  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 upper extremity.
  23. 23. Risks for grafts from the iliac crest 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 syndrome) pelvic instability fracture (extremely rare and usually with other factors)
  24. 24. injury to the cluneal nerves (this will cause posterior pelvic pain which is worsened by sitting) injury to the ilioinguinal nerve infection minor hematoma (a common occurrence) deep hematoma requiring surgical intervention seroma ureteral injury
  25. 25. pseudoaneurysm of iliac artery (rare) tumor transplantation cosmetic defects (chiefly caused by not preserving the superior pelvic brim) chronic pain
  26. 26. Normal results  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.
  27. 27.  Thank you……

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