This document discusses bone grafting in orthopedics. It defines bone grafting as surgically harvesting bone from one site and placing it into another site, either within the same person or between individuals. Bone grafting has several indications including filling bone defects, bridging joints, and promoting bone union. The document discusses the biological concepts of bone grafts, ideal characteristics, advantages, disadvantages, common sites, and classifications of bone grafts. It also provides examples of vascularized fibular and iliac crest grafts and synthetic graft variants made from ceramics. Complications of bone grafting include infection, bleeding, nerve injury, and graft rejection. Autograft is considered the gold standard but stem cell research offers promising

1. Welcome To daily topic presentation
Dr. Md. Ashiqur Rahman
Phase-B Resident

2. Bone graft in Orthopedics

3. Introduction
• Definition :
It is a surgical procedure in which bone is harvested from one
site and placed into another site of the same or different
individual.

4. Indications:
• To fill cavities or defects from cysts, tumors, or other causes
(eg; disease, trauma)
• To bridge joints for arthrodesis.
• To bridge major defects and restore continuity of a long
bone.
• To provide bone block to limit joint motion (arthroreisis).
• To promote union in a pseudoarthrosis (nonunion)
• To promote union in delayed union, malunion, fresh
fractures or osteotomies.

5. Biological concepts of using bone grafts:
• Osteoinduction : Induce differentiation of stem cells into
osteogenic cells.
• Osteoconduction : Provide passive porous scaffold upon which
new bone can form.
• Osteogenesis : Provide stem cell with osteogenic potential,
which directly lays down new bone.

6. Characteristics of ideal bone graft, Boyne in 1973
• Should be readily available.
• Should provide rapid osteogenesis.
• Should not elicit immunological responses.
• Should enhance revascularization.
• Should be highly osteoinductive.
• Should provide for osteoconduction.
• Should not impede bone growth.

7. Advantages of bone graft
• Regeneration of the attachment apparatus is possible.
• It is possible to reverse the disease process.
• All categories of intra-osseous defects and certain functional
defects.
• Idealistic therapeutic objectives may be achievable.

8. Disadvantages of bone graft (Mellonig 1992)
• Increases treatment time.
• Autografts require two sites.
• Increased post-operative care.
• Bone grafts take a long time to heal.
• Availability and the added expense of graft material.
• Technique sensitive.

9. Common sites:

10.  Classification of bone graft
A. According to source:
i) Autogenous graft
ii) Allogenic graft
iii) Heterogenic graft
iv) Isograft

11. B. Accoding to structure:
i) Cortical graft
ii) Cancellous graft
iii) Cortico-cancellous graft

12. C. According to vascularity :
i) Vascularized graft
ii) Non-vascularized graft

14. 2. Vascularized fibular graft in AVN:

15. 3. Fibular graft in chronic osteomyelitis:

16. 4. Vascularized graft from the iliac crest:
• Vascularized graft can also be
taken from the iliac crest with
deep circumflex arterial pedicle.

17. D. According to various technique:
i) Onlay cortical graft:
Until relatively inert metal
became available, the onlay bone
graft was the simple and most
important treatment for most
ununited diaphyseal fracture.

18. ii) Inlay graft:
By the inlay technique a slot of rectangular defect in created
in the cortex of the host bone usually with a power saw.
A graft the same size or slightly smaller is then fitted into the
defect.

19. iii) Strut graft:
Is commonly used for anterior spinal fusion.
Strut grafts are very useful for bridging the defects in the
anterior spine and for providing support for anterior spinal
fusion.
Grafts from the ribs, fibula, and bicortical iliac crest are useful
for strut grafting, depending on the size of the graft needed.

20. Anterior spinal fusion with strut graft:

21. iv) Bone graft in GCT (Sandwich technique)

22. Synthetic variants:
• Artificial grafts are created from ceramics
such as calcium phosphate(eg.
Hydroxyapatite and tricalcium phosphate),
bioglass and calcium sulphate.
• All of which are biologically active depending
on the solubility in the physiological
environment.

23. Complications:
• Infection
• Bleeding
• Nerve injury
• Pelvic fracture
• Graft rejection
• Complications from the anesthesia

24. Take Home Message
• Autograft is gold standard.
• Do not hesitate to do bone graft when required.
• Stem cell research is underway and has promising prospects.

25. References:
1. CAMPBELL’S OPERATIVE ORTHOPAEDICS-13TH EDITION
2. APLEY & SOLOMON’S SYSTEM OF ORTHOPAEDICS AND TRAUMA-
10TH EDITION
3. INTERNET