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Bone grafting

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Dr. Hitendra Patil registrar

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Bone grafting

  1. 1. Bone Grafting<br />Dr. HitendraPatil<br />Department of Orthopaedics<br />ESIPGIMSR MGM HOSPITAL<br />
  2. 2. Introduction<br />Bone grafting is a surgical procedure done in order to fill the defects in cortical and cancellous bones formed secondary to <br />Trauma<br />Tumor<br />Infections and other conditions<br />to fasten the bone healing <br />
  3. 3.  Bone grafts may be <br />Autograft<br />Bone harvested from the patient’s own body<br />Allograft<br />Cadaveric bone (usually obtained from a bone bank)<br />Synthetic <br />Often made of hydroxyapatite or other naturally-occurring and biocompatible substances with similar mechanical properties to bone. <br />
  4. 4. Classification<br />Origin:<br />Autogenous<br />Allogenous<br />Blood supply:<br />Nonvascularised<br />Vascularised<br />Type of bone :<br />Cortical <br />Cancellous<br />Corticocancellous<br />
  5. 5. Indications<br />
  6. 6. Indications<br /><ul><li>To promote union or fill defects in </li></ul>Fresh fractures<br />Delayed union <br />Malunion<br />Osteotomies<br />
  7. 7. Indications<br /><ul><li>To fill cavities/defects resulting from cysts, tumors etc </li></li></ul><li>Indications<br /><ul><li>To bridge joints and provide arthrodesis</li></li></ul><li>Sites of Aoutogenous bone graft<br />Cortical <br />Fibula ,Rib <br />Cancellous<br />Iliac crest,ProximalTibia,Radius<br />Corticocancellous<br />Iliac crest <br />
  8. 8. Essential properties of bone graft<br />
  9. 9. Essential properties of bone graft<br />Osteogenesis<br />Synthesis of new bone from the cells derived from graft and host<br />
  10. 10. Essential properties of bone graft<br />Osteogenesis<br />Synthesis of new bone from cells derived from graft and host<br />Osteoinduction<br />Stimulation of synthesis<br />Growth factor is responsible (BMP)<br />
  11. 11. Essential properties of bone graft<br />Osteogenesis<br />Synthesis of new bone from cells derived from graft and host<br />Osteoinduction<br />Stimulation of synthesis<br />Growth factor is responsible (BMP)<br />Osteoconduction<br />Provision of scaffold for formation of new bone<br />
  12. 12. Autogenous grafts<br />Ideal as a bone graft <br />As possesses all characteristics necessary for new bone growth<br />Osteoconductivity<br />Osteogenicity<br />Osteoinductivity. <br />
  13. 13. Include <br />Cancellous<br />Vascularized cortical<br />Nonvascularized cortical<br />Autologous bone marrow grafts<br />
  14. 14. Disadvantage<br />Donor site morbidity<br />i.e.harvestingautograft requires an additional surgery at the donor site which has its own complications- inflammation, infection, and chronic pain .<br />Quantities of bone tissue that can be harvested are also limited. <br />
  15. 15. Allogenic Grafts <br />Obtained from a person other than the patient.<br />Advantage –<br />No donor site morbidity<br />Large amount can be used <br />
  16. 16. Properties of Autografts and Allografts<br />
  17. 17. Properties of Autografts and Allografts<br />
  18. 18. Properties of Autografts and Allografts<br />
  19. 19. Properties of Autografts and Allografts<br />
  20. 20. Properties of Autografts and Allografts<br />
  21. 21. Properties of Autografts and Allografts<br />
  22. 22. Properties of Autografts and Allografts<br />
  23. 23. Properties of Autografts and Allografts<br />
  24. 24. Properties of Autografts and Allografts<br />
  25. 25. Incorporation of graft<br />Primary phase-<br />Hemorrhage<br />Inflammation <br />Accumulation of haemopoietic cells including neutrophills, macrophages and osteoclasts<br />Removal of necrotic bone<br />
  26. 26. Osteoconductive factors released from graft during resorption and cytokines released during inflammation<br />Recruitment and stimulation of mesenchymal stem cells to osteogenic cells<br />Active bone formation<br />
  27. 27. Second phase<br />Osteoblasts lines dead trabecule and lay down osteoid<br />Haemopoietic marrow cells forms new marrow in transplanted bone<br />Remodeling i.e. woven bone slowly being transformed into lamellar bone by coordinated activities of osteoblasts and osteoclasts<br />Incorporation of graft<br />
  28. 28. Host response to cancellusbonegraft differs from cortical<br />In cortical bone graft first osteoclasticresoption then ostioblastic activity<br />Where as in cancellous bone graft bone formation and resorption occurs simultaneously called creeping substitution<br />Therefore cancellous bone graft incorporates quickly<br />But does not provides immediate structural support<br />
  29. 29. Fracture shaft of Radius and Ulna with segmental bone loss<br />
  30. 30. Tricorticalilliac crest graft for shaft of radius<br />Nonvacularised fibula graft for ulna<br />
  31. 31. Thank You<br />

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