Abstract
Bone grafting is the treatment of choice for fracture non-unions and bone defects. From the incipient era of xenografts, bone grafting methodology has evolved many folds, to deliver a safe and more predictable outcome. The autografts have remained the preferred choice for most applications; however, their use is limited by the quantity of graft available and the donor site morbidity. Vascularized bone grafts (free or pedicled) have the advantage of the graft retaining its own blood supply and hence facilitate the healing process, especially with limited recipient site vascularity. The allografts and demineralized bone matrix are used when large quantities of grafts are needed. The risk of antigenicity (and subsequent rejection) and transmission of diseases remains a possibility, even after meticulous preparation.
Newer bone substitutes, like synthetic grafts of tricalcium phosphate and hydroxyapatite, have shown osteoconductive properties and high compressive strength and are being used either plain or impregnated with biologically active substances like growth factors.
Bone marrow aspirate concentrate is considered useful in the treatment of fracture delayed unions and management of osteoarthritis and chondral lesions in the knee, due to their high contents of growth factors. These have a limited number of progenitor cells, and hence, cultured autologous osteoblasts have found clinical application especially in the treatment of avascular necrosis of the femoral head. Bone growth factors like bone morphogenetic proteins (BMPs) improve the local milieu and promote healing due to osteoinductive properties. Sometimes, two or more types of graft are used in conjunction to improve the outcome.
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Gautam, V., Vaish, A., Vaishya, R. (2023). Principles of Bone Grafting. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_26
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DOI: https://doi.org/10.1007/978-981-19-7540-0_26
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