Dr. Vishal Thakur sr resident

1. BONE GRAFT SUBSTITUTES DR. VISHAL THAKUR SENIOR RESIDENT DEPARTMENT OF ORTHOPAEDICS ESIPGIMSR MGMH PAREL

2. BONE AS A TRANSPLANT TISSUE MINERAL COMPONANT – STRUCTURAL INTEGRITY AND COMPRESSIVE STRENGTH COLLAGENOUS MATRIX – TYPE I COLLAGEN AND NONCOLLAGENOUS MATRIX GROWTH FACTOR COMPONANT – VARIOUS BONE MORPHOGENIC PROTEINS (5% OF THE BONE)

3. WHY ARE WE INTERESTED IN BONE GRAFT ALTERNATIVES BONE GRAFT MORBIDITY- 9% 1. PROLONGED WOUND DRAINAGE 2. HEMATOMAS 3. INFECTIONS 4. NERVE INJURY 5. PROLONGED PAIN LARGER THE AMOUNT OF GRAFT MORE ARE THE LIKELIHOOD OF COMPLICATIONS AUTOLOGUS BONE GRAFT IS NOT SUFFICIENT IN SOME CASES LIKE BONE CYSTS, BONE DEFECTS, TUMORS ETC….

4. WHAT ARE THE ALTERNATIVES TO AUTOLOGOUS BONE GRAFTING ALLOGRAFTS DEMINERALIZED BONE MATRIX (ENGINEERED ALLOGRAFTS) BONE MARROW INJECTIONS, (OSTEOPROGENITOR CELLS) BMP INJECTIONS (OSTEOINDUCTOR) SYNTHETIC BONE GRAFTS (OSTEOCONDUCTOR) 1. CORAL HYDROXYAPETITE 2.TRICALCIUM PHOSPHATES 3. CALSIUM SULFATE 4. COLLAGEN SUBSTRATES

5. ALLOGRAFTS AVAILABLE AS FRESH FROZEN FREEZE DRIED DEMINERALIZED PREDOMINANTLY IN TUMOR AND RECONSTRUCTIVE HIP AND KNEE SURGERY PROBLEMS – HIGH PROCUREMENT COST CHANCES OF DISEASE TRANSMISSION (LESS NOW) IMMUNE REJECTION PROBLEM ( LESS WITH DBM) INCONSISTANT INCORPORATION ( PREDOMINANLY OSTEOCONDUCTOR)

7. DEMINERALIZED BONE MATRIX OSTEOGENIC ACTIVITIES. USUALLY MIXED WITH ALLOGRAFT PROBLEM – VERY SOLUBLE AND DIFFICULT TO CONTAIN IN IMPLANTATION SITE. GRAFTON – BASICALLY DBM AS GEL OPTIFORM – DBM + COLLAGEN – THERMOPLASTIC. AT BODY TEMPERATURE IT HARDENS TO THE CONSISTENCEY OF CANCELLOUS BONE

9. SYNTHETIC BONE GRAFT SUBSTITUTES ENGINEERED MATRIX MATERIAL ENAHANCE FRACTURE HEALING WITH NO MORBIDITY AND NO RISK OF DISEASE TRANSMISSION MIXTURE OF OSTEOGENIC, OSTEOINDUCTOR AND OSTEOCONDUCTIVE INGRDIENT TO MIMIC AUTOLOGOUS BONE GRAFT USUALLY MIXING COLLAGEN, MINERAL AND GROWTH FACTOR COMPONANT WITH OSTEOPROGENITOR CELLS.

11. CORAL HYROXYAPETITE INTERPORE, PRE OSTEON SOUTH SEA CORAL SKELETONS CONVERTED TO PURE CRYSTALLINE HYDROXYAPETITE POROUS STRUCTURE SIMILAR TO CANCELLOUS BONE OSTEOCONDUCTIVE SIGNIFICANT INTERCONNECTIVITY TO FAVOUR FIBROVASCULAR INGROWTH

12. PROBLEM- MINIMAL REMODELLING DUE TO HIGH CRYSTALLINE AND INSOLUBLE NATURE OF MATERIAL. OSTEOCLAST CANNOT RESORB IT SO THESE MATERIALS WHEN USED LIVES INGRAFT BED FOR LIFE TIME USEFUL IN CANCELLOUS BONES AS THEY PROVIDE IMMEDIATE SUPPORT AND RAPID INGROWTH AND HEALING OF CANCELLOUS BONES NOT USEFUL IN DIAPHYSEAL FRACTURES WHERE STRUCTURAL INTEGRITY REQUIRED

13. MINERAL COMPOSITES SINTERED HA/TCP, CALSIUM SULPHATES, NONCRYSTALLINE APETITES, BIOGLASS BIOGLASS AND NONCRYSTALLINE APETITIES ARE INJECTED AS LIQUIDS WHICH HARDENS IN THE BONE SITE. TCP, CALCIUM SULPHATES DISSOLVES RAPIDLY AND CREATE HIGH Ca/P SOLUBILITY PRODUCTS THEY ARE OSTEOCONDUCTIVE, STRUCTURAL AND RESORBABLE SINCE THEY ARE NONCRYSTALLINE THEY UNDERGO COMPLETE OSTEOCLAST RESORPTION

14. COLLAGEN OSTEOCONDUCTIVE IDEAL SUBSTRATE FOR MINERAL COMPOSITES BINDS TO CIRCULATING GROWTH FACTORS ENHANCES MINERAL CONTAINTS OSTEOINDUCTIVITY

16. BONE MORPHOGENIC PROTEINS OSTEOINDUCTIVE COMMITS STEM CELLS TO BECOME OSTEOPROGENITOR CELLS ACTIVELY EXPRESSED IN FRACTURE CALLUS

17. TAKE HOME MESSAGE AUTOGRAFT IS GOLD STANDARD. GOOD SURGICAL SKILLS AND TISSUE HANDLING IS VERY IMPORTANT IN OPERATIVE FRACTURE MANAGEMENT. DO NOT HESITATE TO DO BONE GRAFT WHEN REQUIRED VIGILANT TO DIAGNOSE NON UNION EARLY STEM CELL RESEARCH IS UNDERWAY AND HAS PROMISING PROSPECTS.

18. THANK YOU….