Bone grafting
-
Upload
esicpgimsr-mgm-parel-department-of-orthopedics -
Category
Health & Medicine
-
view
17.561 -
download
0
Transcript of Bone grafting
![Page 1: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/1.jpg)
Bone GraftingDr. Hitendra Patil
Department of OrthopaedicsESIPGIMSR MGM HOSPITAL
![Page 2: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/2.jpg)
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 conditionsto fasten the bone healing
![Page 3: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/3.jpg)
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.
![Page 4: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/4.jpg)
ClassificationOrigin:
−Autogenous−Allogenous
Blood supply:−Nonvascularised−Vascularised
Type of bone :−Cortical −Cancellous −Corticocancellous
![Page 5: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/5.jpg)
Indications
![Page 6: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/6.jpg)
IndicationsTo promote union
or fill defects in –Fresh fractures–Delayed union –Malunion–Osteotomies
![Page 7: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/7.jpg)
IndicationsTo fill
cavities/defects resulting from cysts, tumors etc
![Page 8: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/8.jpg)
IndicationsTo bridge joints and provide
arthrodesis
![Page 9: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/9.jpg)
Sites of Aoutogenous bone graft
Cortical – Fibula ,Rib
Cancellous – Iliac crest,Proximal Tibia,Radius
Corticocancellous – Iliac crest
![Page 10: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/10.jpg)
Essential properties of bone graft
![Page 11: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/11.jpg)
Essential properties of bone graft
Osteogenesis–Synthesis of new bone from the
cells derived from graft and host
![Page 12: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/12.jpg)
Essential properties of bone graft
Osteogenesis–Synthesis of new bone from cells
derived from graft and hostOsteoinduction–Stimulation of synthesis–Growth factor is responsible (BMP)
![Page 13: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/13.jpg)
Essential properties of bone graft
Osteogenesis–Synthesis of new bone from cells
derived from graft and hostOsteoinduction–Stimulation of synthesis–Growth factor is responsible (BMP)
Osteoconduction–Provision of scaffold for formation
of new bone
![Page 14: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/14.jpg)
Autogenous graftsIdeal as a bone graft –As possesses all characteristics
necessary for new bone growth
−Osteoconductivity−Osteogenicity−Osteoinductivity.
![Page 15: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/15.jpg)
Include –Cancellous–Vascularized cortical–Nonvascularized cortical–Autologous bone marrow grafts
![Page 16: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/16.jpg)
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.
![Page 17: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/17.jpg)
Allogenic Grafts Obtained from a person other than
the patient.Advantage ––No donor site morbidity– Large amount can be used
![Page 18: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/18.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 19: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/19.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 20: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/20.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 21: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/21.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 22: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/22.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 23: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/23.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 24: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/24.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 25: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/25.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 26: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/26.jpg)
Properties of Autografts and Allografts Bone graft
Structural strength
Osteo-conducton
Osteo-induction
Osteo -genesis
Autograft
Cancellous No +++ +++ +++
Cortical +++ ++ ++ ++
Allograft
Cancellous
No ++ + No
Cortical +++ + No No
![Page 27: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/27.jpg)
Incorporation of graftPrimary phase-–Hemorrhage– Inflammation –Accumulation of haemopoietic cells
including neutrophills, macrophages and osteoclasts
–Removal of necrotic bone
![Page 28: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/28.jpg)
–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
![Page 29: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/29.jpg)
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
![Page 30: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/30.jpg)
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
![Page 31: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/31.jpg)
Fracture shaft of Radius and Ulna with segmental bone loss
![Page 32: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/32.jpg)
Tricortical illiac crest graft for shaft of radius
Nonvacularised fibula graft for ulna
![Page 33: Bone grafting](https://reader034.fdocuments.us/reader034/viewer/2022051404/542606978d7f7218278b6755/html5/thumbnails/33.jpg)
Thank You