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Bone grafting
 
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Dr. Hitendra Patil registrar

Dr. Hitendra Patil registrar

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    Bone grafting Bone grafting Presentation Transcript

    • Bone Grafting
      Dr. HitendraPatil
      Department of Orthopaedics
      ESIPGIMSR MGM HOSPITAL
    • 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
    •  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.
    • Classification
      Origin:
      Autogenous
      Allogenous
      Blood supply:
      Nonvascularised
      Vascularised
      Type of bone :
      Cortical
      Cancellous
      Corticocancellous
    • Indications
    • Indications
      • To promote union or fill defects in
      Fresh fractures
      Delayed union
      Malunion
      Osteotomies
    • Indications
      • To fill cavities/defects resulting from cysts, tumors etc
    • Indications
      • To bridge joints and provide arthrodesis
    • Sites of Aoutogenous bone graft
      Cortical
      Fibula ,Rib
      Cancellous
      Iliac crest,ProximalTibia,Radius
      Corticocancellous
      Iliac crest
    • Essential properties of bone graft
    • Essential properties of bone graft
      Osteogenesis
      Synthesis of new bone from the cells derived from graft and host
    • 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)
    • 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
    • Autogenous grafts
      Ideal as a bone graft
      As possesses all characteristics necessary for new bone growth
      Osteoconductivity
      Osteogenicity
      Osteoinductivity.
    • Include
      Cancellous
      Vascularized cortical
      Nonvascularized cortical
      Autologous bone marrow grafts
    • Disadvantage
      Donor site morbidity
      i.e.harvestingautograft 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.
    • Allogenic Grafts
      Obtained from a person other than the patient.
      Advantage –
      No donor site morbidity
      Large amount can be used
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Properties of Autografts and Allografts
    • Incorporation of graft
      Primary phase-
      Hemorrhage
      Inflammation
      Accumulation of haemopoietic cells including neutrophills, macrophages and osteoclasts
      Removal of necrotic bone
    • 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
    • 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
    • Host response to cancellusbonegraft differs from cortical
      In cortical bone graft first osteoclasticresoption 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
    • Fracture shaft of Radius and Ulna with segmental bone loss
    • Tricorticalilliac crest graft for shaft of radius
      Nonvacularised fibula graft for ulna
    • Thank You