bone grafting in ortopedics

1. Bone Grafting
Dr. Amr Mansour
Orthopedic surgeon

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

6. Indications

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

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

9. Indications
To bridge joints and provide arthrodesis

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

11. Essential properties of bone graft

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

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

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

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. Properties of Autografts and
Allografts

28. Risk and complications
 Disease transmission , like HIV
Hepatitis c and B
 Wound drainage with calcium
sulphate

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

30. – Osteoconductive factors released
from graft during resorption
– Recruitment and stimulation of
mesenchymal stem cells to
osteogenic cells
– Active bone formation

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. Fracture shaft of Radius and Ulna
with segmental bone loss

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

34. Thank You