BONE GRAFT SUBSTITUTES<br />DR. VISHAL THAKUR<br />SENIOR RESIDENT<br />DEPARTMENT OF ORTHOPAEDICS<br />ESIPGIMSR MGMH PAR...
BONE AS A TRANSPLANT TISSUE<br />MINERAL COMPONANT – STRUCTURAL INTEGRITY AND COMPRESSIVE STRENGTH<br />COLLAGENOUS MATRIX...
WHY ARE WE INTERESTED IN BONE GRAFT ALTERNATIVES<br />BONE GRAFT MORBIDITY- 9%<br />    1. PROLONGED WOUND DRAINAGE<br /> ...
WHAT ARE THE ALTERNATIVES TO AUTOLOGOUS BONE GRAFTING<br />ALLOGRAFTS<br />DEMINERALIZED BONE MATRIX (ENGINEERED ALLOGRAFT...
ALLOGRAFTS<br />AVAILABLE AS <br />FRESH FROZEN<br />FREEZE DRIED <br />DEMINERALIZED<br /> PREDOMINANTLY IN TUMOR AND REC...
DEMINERALIZED BONE MATRIX<br />OSTEOGENIC ACTIVITIES. USUALLY MIXED WITH ALLOGRAFT<br />PROBLEM – VERY SOLUBLE AND DIFFICU...
SYNTHETIC BONE GRAFT SUBSTITUTES<br />ENGINEERED MATRIX MATERIAL<br />ENAHANCE FRACTURE HEALING WITH NO MORBIDITY AND NO R...
CORAL HYROXYAPETITE<br />INTERPORE, PRE OSTEON<br />SOUTH SEA CORAL SKELETONS CONVERTED TO PURE CRYSTALLINE HYDROXYAPETITE...
PROBLEM-<br />MINIMAL REMODELLING DUE TO HIGH CRYSTALLINE AND INSOLUBLE NATURE OF MATERIAL.<br />OSTEOCLAST CANNOT RESORB ...
MINERAL COMPOSITES<br />SINTERED HA/TCP, CALSIUM SULPHATES, NONCRYSTALLINE APETITES, BIOGLASS<br />BIOGLASS AND NONCRYSTAL...
COLLAGEN<br />OSTEOCONDUCTIVE<br />IDEAL SUBSTRATE FOR MINERAL COMPOSITES<br />BINDS TO CIRCULATING GROWTH FACTORS<br />EN...
BONE MORPHOGENIC PROTEINS<br />OSTEOINDUCTIVE<br />COMMITS STEM CELLS TO BECOME OSTEOPROGENITOR CELLS<br />ACTIVELY EXPRES...
TAKE HOME MESSAGE<br />AUTOGRAFT IS GOLD STANDARD.<br />GOOD SURGICAL SKILLS AND TISSUE HANDLING IS VERY IMPORTANT IN OPER...
THANK YOU….<br />
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bone graft substitutes

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Dr. Vishal Thakur
sr resident

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bone graft substitutes

  1. 1. BONE GRAFT SUBSTITUTES<br />DR. VISHAL THAKUR<br />SENIOR RESIDENT<br />DEPARTMENT OF ORTHOPAEDICS<br />ESIPGIMSR MGMH PAREL<br />
  2. 2. BONE AS A TRANSPLANT TISSUE<br />MINERAL COMPONANT – STRUCTURAL INTEGRITY AND COMPRESSIVE STRENGTH<br />COLLAGENOUS MATRIX – TYPE I COLLAGEN AND NONCOLLAGENOUS MATRIX<br />GROWTH FACTOR COMPONANT – VARIOUS BONE MORPHOGENIC PROTEINS (5% OF THE BONE) <br />
  3. 3. WHY ARE WE INTERESTED IN BONE GRAFT ALTERNATIVES<br />BONE GRAFT MORBIDITY- 9%<br /> 1. PROLONGED WOUND DRAINAGE<br /> 2. HEMATOMAS <br /> 3. INFECTIONS<br /> 4. NERVE INJURY<br /> 5. PROLONGED PAIN<br />LARGER THE AMOUNT OF GRAFT MORE ARE THE LIKELIHOOD OF COMPLICATIONS<br />AUTOLOGUS BONE GRAFT IS NOT SUFFICIENT IN SOME CASES LIKE<br /> BONE CYSTS, BONE DEFECTS, TUMORS ETC….<br />
  4. 4. WHAT ARE THE ALTERNATIVES TO AUTOLOGOUS BONE GRAFTING<br />ALLOGRAFTS<br />DEMINERALIZED BONE MATRIX (ENGINEERED ALLOGRAFTS)<br />BONE MARROW INJECTIONS, (OSTEOPROGENITOR CELLS)<br />BMP INJECTIONS (OSTEOINDUCTOR)<br />SYNTHETIC BONE GRAFTS (OSTEOCONDUCTOR)<br /> 1. CORAL HYDROXYAPETITE<br /> 2.TRICALCIUM PHOSPHATES<br /> 3. CALSIUM SULFATE<br /> 4. COLLAGEN SUBSTRATES<br />
  5. 5. ALLOGRAFTS<br />AVAILABLE AS <br />FRESH FROZEN<br />FREEZE DRIED <br />DEMINERALIZED<br /> PREDOMINANTLY IN TUMOR AND RECONSTRUCTIVE HIP AND KNEE SURGERY<br />PROBLEMS – <br />HIGH PROCUREMENT COST<br />CHANCES OF DISEASE TRANSMISSION (LESS NOW)<br />IMMUNE REJECTION PROBLEM ( LESS WITH DBM)<br />INCONSISTANT INCORPORATION ( PREDOMINANLY OSTEOCONDUCTOR)<br />
  6. 6.
  7. 7. DEMINERALIZED BONE MATRIX<br />OSTEOGENIC ACTIVITIES. USUALLY MIXED WITH ALLOGRAFT<br />PROBLEM – VERY SOLUBLE AND DIFFICULT TO CONTAIN IN IMPLANTATION SITE.<br />GRAFTON – BASICALLY DBM AS GEL<br />OPTIFORM – DBM + COLLAGEN – THERMOPLASTIC. AT BODY TEMPERATURE IT HARDENS TO THE CONSISTENCEY OF CANCELLOUS BONE<br />
  8. 8.
  9. 9. SYNTHETIC BONE GRAFT SUBSTITUTES<br />ENGINEERED MATRIX MATERIAL<br />ENAHANCE FRACTURE HEALING WITH NO MORBIDITY AND NO RISK OF DISEASE TRANSMISSION<br />MIXTURE OF OSTEOGENIC, OSTEOINDUCTOR AND OSTEOCONDUCTIVE INGRDIENT TO MIMIC AUTOLOGOUS BONE GRAFT<br />USUALLY MIXING COLLAGEN, MINERAL AND GROWTH FACTOR COMPONANT WITH OSTEOPROGENITOR CELLS.<br />
  10. 10.
  11. 11. CORAL HYROXYAPETITE<br />INTERPORE, PRE OSTEON<br />SOUTH SEA CORAL SKELETONS CONVERTED TO PURE CRYSTALLINE HYDROXYAPETITE<br />POROUS STRUCTURE SIMILAR TO CANCELLOUS BONE<br />OSTEOCONDUCTIVE<br />SIGNIFICANT INTERCONNECTIVITY TO FAVOUR FIBROVASCULAR INGROWTH<br />
  12. 12. PROBLEM-<br />MINIMAL REMODELLING DUE TO HIGH CRYSTALLINE AND INSOLUBLE NATURE OF MATERIAL.<br />OSTEOCLAST CANNOT RESORB IT SO THESE MATERIALS WHEN USED LIVES INGRAFT BED FOR LIFE TIME<br /> USEFUL IN CANCELLOUS BONES AS THEY PROVIDE IMMEDIATE SUPPORT AND RAPID INGROWTH AND HEALING OF CANCELLOUS BONES<br />NOT USEFUL IN DIAPHYSEAL FRACTURES WHERE STRUCTURAL INTEGRITY REQUIRED<br />
  13. 13. MINERAL COMPOSITES<br />SINTERED HA/TCP, CALSIUM SULPHATES, NONCRYSTALLINE APETITES, BIOGLASS<br />BIOGLASS AND NONCRYSTALLINE APETITIES ARE INJECTED AS LIQUIDS WHICH HARDENS IN THE BONE SITE. <br />TCP, CALCIUM SULPHATES DISSOLVES RAPIDLY AND CREATE HIGH Ca/P SOLUBILITY PRODUCTS<br />THEY ARE OSTEOCONDUCTIVE, STRUCTURAL AND RESORBABLE<br />SINCE THEY ARE NONCRYSTALLINE THEY UNDERGO COMPLETE OSTEOCLAST RESORPTION<br />
  14. 14. COLLAGEN<br />OSTEOCONDUCTIVE<br />IDEAL SUBSTRATE FOR MINERAL COMPOSITES<br />BINDS TO CIRCULATING GROWTH FACTORS<br />ENHANCES MINERAL CONTAINTS OSTEOINDUCTIVITY<br />
  15. 15.
  16. 16. BONE MORPHOGENIC PROTEINS<br />OSTEOINDUCTIVE<br />COMMITS STEM CELLS TO BECOME OSTEOPROGENITOR CELLS<br />ACTIVELY EXPRESSED IN FRACTURE CALLUS<br />
  17. 17. TAKE HOME MESSAGE<br />AUTOGRAFT IS GOLD STANDARD.<br />GOOD SURGICAL SKILLS AND TISSUE HANDLING IS VERY IMPORTANT IN OPERATIVE FRACTURE MANAGEMENT.<br />DO NOT HESITATE TO DO BONE GRAFT WHEN REQUIRED<br />VIGILANT TO DIAGNOSE NON UNION EARLY<br />STEM CELL RESEARCH IS UNDERWAY AND HAS PROMISING PROSPECTS.<br />
  18. 18. THANK YOU….<br />
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