Bone grafting is a surgical technique used to repair defects in bones due to trauma, tumors, or infections and involves various types such as autografts, allografts, and synthetic grafts. Essential properties of bone grafts include osteogenesis, osteoinduction, and osteoconduction, with autografts being ideal despite donor site morbidity. The incorporation of grafts involves a two-phase process that includes inflammation, removal of necrotic bone, and the stimulation of new bone formation.

1. Bone Grafting
Dr. Hitendra Patil
Department of Orthopaedics
ESIPGIMSR MGM HOSPITAL

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.  Bone grafts may be
1. Autograft
− Bone harvested from the patient’s own
body
2. Allograft
− Cadaveric bone (usually obtained from
a bone bank)
3. Synthetic
− Often made of hydroxyapatite or other
naturally-occurring and
biocompatible substances with similar
mechanical properties to bone.

4. Classification
Origin:
−Autogenous
−Allogenous
Blood supply:
−Nonvascularised
−Vascularised
Type of bone :
−Cortical
−Cancellous
−Corticocancellous

5. Indications

6. Indications
To promote union or
fill defects in
–Fresh fractures
–Delayed union
–Malunion
–Osteotomies

7. Indications
To fill
cavities/defects
resulting from
cysts, tumors etc

8. Indications
To bridge joints and provide arthrodesis

9. Sites of Aoutogenous bone graft
Cortical
– Fibula ,Rib
Cancellous
– Iliac crest,Proximal Tibia,Radius
Corticocancellous
– Iliac crest

10. Essential properties of bone graft

11. Essential properties of bone graft
Osteogenesis
–Synthesis of new bone from the
cells derived from graft and host

12. 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)

13. 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

14. Autogenous grafts
Ideal as a bone graft
– As possesses all characteristics
necessary for new bone growth
−Osteoconductivity
−Osteogenicity
−Osteoinductivity.

15. Include
– Cancellous
– Vascularized cortical
– Nonvascularized cortical
– Autologous bone marrow grafts

16. 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.

17. Allogenic Grafts
Obtained from a person other than
the patient.
Advantage –
– No donor site morbidity
– Large amount can be used

18. Properties of Autografts and
Allografts

19. Properties of Autografts and
Allografts

20. Properties of Autografts and
Allografts

21. Properties of Autografts and
Allografts

22. Properties of Autografts and
Allografts

23. Properties of Autografts and
Allografts

24. Properties of Autografts and
Allografts

25. Properties of Autografts and
Allografts

26. Properties of Autografts and
Allografts

27. Incorporation of graft
Primary phase-
– Hemorrhage
– Inflammation
– Accumulation of haemopoietic cells
including neutrophills, macrophages
and osteoclasts
– Removal of necrotic bone

28. – 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

29. 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

30. Host response to cancellus
bonegraft differs from cortical
– In cortical bone graft first osteoclastic
resoption 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

31. Fracture shaft of Radius and Ulna
with segmental bone loss

32. Tricortical illiac crest graft for shaft
of radius
Nonvacularised fibula graft for ulna

33. Thank You