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Bone Grafting
Dr. Amr Mansour
Orthopedic surgeon
Introduction
 Bone grafting is a surgical procedure
done in order to fill the defects in
cortical and cancellous bones
fo...
 Bone grafts may be
Autograft
− Bone harvested from the patient’s own
body
Allograft
− Cadaveric bone (usually obtained f...
Demineralized bone matrix
− Acidic extraction of bone
matrix from allograft removes the
minerals and leaves the collagenou...
Classification
Origin:
−Autogenous
−Allogenous
Blood supply:
−Nonvascularised
−Vascularised
Type of bone :
−Cortical
−C...
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,Proximal Tibia,Radius
Corticocancellous...
Essential properties of bone graft
Essential properties of bone graft
Osteogenesis
–Synthesis of new bone from the
cells derived from graft and host
includi...
Essential properties of bone graft
Osteogenesis
–Synthesis of new bone from cells
derived from graft and host
Osteoinduc...
Essential properties of bone graft
Osteogenesis
–Synthesis of new bone from cells
derived from graft and host
Osteoinduc...
Autogenous grafts
Ideal as a bone graft
– As possesses all characteristics
necessary for new bone growth
−Osteoconductivi...
Include
– Cancellous
– Vascularized cortical
– Nonvascularized cortical
– Autologous bone marrow grafts
Disadvantage
– Donor site morbidity
−i.e.harvesting autograft requires an
additional surgery at the donor site
which has ...
Allogenic Grafts
Obtained from a person other than
the patient.
Advantage –
– No donor site morbidity
– Large amount can...
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
Risk and complications
 Disease transmission , like HIV
Hepatitis c and B
 Wound drainage with calcium
sulphate
Incorporation of graft
Primary phase-
– Inflammation
– Accumulation of haemopoietic cells
including neutrophills, macroph...
– Osteoconductive factors released
from graft during resorption
– Recruitment and stimulation of
mesenchymal stem cells to...
Second phase
– Osteoblasts lines dead trabecule and
lay down osteoid
– Haemopoietic marrow cells forms
new marrow in tran...
Fracture shaft of Radius and Ulna
with segmental bone loss
Tricortical illiac crest graft for shaft
of radius
Nonvacularised fibula graft for ulna
Thank You
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Bone Grafting In Orthopedic

  1. 1. Bone Grafting Dr. Amr Mansour Orthopedic surgeon
  2. 2. 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
  3. 3.  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.
  4. 4. Demineralized bone matrix − Acidic extraction of bone matrix from allograft removes the minerals and leaves the collagenous and noncollagenous structure and proteins Reamer Aspirator Irrigator − Provides large volume of bone graft from intramedullary source stem cells Xenograft from animals
  5. 5. Classification Origin: −Autogenous −Allogenous Blood supply: −Nonvascularised −Vascularised Type of bone : −Cortical −Cancellous −Corticocancellous
  6. 6. Indications
  7. 7. Indications To promote union or fill defects in –Fresh fractures –Delayed union –Malunion –Osteotomies
  8. 8. Indications To fill cavities/defects resulting from cysts, tumors etc
  9. 9. Indications To bridge joints and provide arthrodesis
  10. 10. Sites of Aoutogenous bone graft Cortical – Fibula ,Rib Cancellous – Iliac crest,Proximal Tibia,Radius Corticocancellous – Iliac crest
  11. 11. Essential properties of bone graft
  12. 12. Essential properties of bone graft Osteogenesis –Synthesis of new bone from the cells derived from graft and host including primitive mesenchymal stem cells, osteoblasts, and osteocytes
  13. 13. Essential properties of bone graft Osteogenesis –Synthesis of new bone from cells derived from graft and host Osteoinduction –Stimulation of synthesis , factors that stimulate bone growth –Growth factor is responsible (BMP) Bone morphogenic protein
  14. 14. 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 –material acts as a structural framework for bone growth
  15. 15. Autogenous grafts Ideal as a bone graft – As possesses all characteristics necessary for new bone growth −Osteoconductivity −Osteogenicity −Osteoinductivity.
  16. 16. Include – Cancellous – Vascularized cortical – Nonvascularized cortical – Autologous bone marrow grafts
  17. 17. Disadvantage – Donor site morbidity −i.e.harvesting autograft 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.
  18. 18. Allogenic Grafts Obtained from a person other than the patient. Advantage – – No donor site morbidity – Large amount can be used
  19. 19. Properties of Autografts and Allografts
  20. 20. Properties of Autografts and Allografts
  21. 21. Properties of Autografts and Allografts
  22. 22. Properties of Autografts and Allografts
  23. 23. Properties of Autografts and Allografts
  24. 24. Properties of Autografts and Allografts
  25. 25. Properties of Autografts and Allografts
  26. 26. Properties of Autografts and Allografts
  27. 27. Properties of Autografts and Allografts
  28. 28. Risk and complications  Disease transmission , like HIV Hepatitis c and B  Wound drainage with calcium sulphate
  29. 29. Incorporation of graft Primary phase- – Inflammation – Accumulation of haemopoietic cells including neutrophills, macrophages and osteoclasts – Removal of necrotic bone
  30. 30. – Osteoconductive factors released from graft during resorption – Recruitment and stimulation of mesenchymal stem cells to osteogenic cells – Active bone formation
  31. 31. 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
  32. 32. Fracture shaft of Radius and Ulna with segmental bone loss
  33. 33. Tricortical illiac crest graft for shaft of radius Nonvacularised fibula graft for ulna
  34. 34. Thank You
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bone grafting in ortopedics

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