Bone grafting

Bone grafting
An operation whereby pieces of
bones taken from some part of
patients body are placed at another
site
Bone grafts are sometimes taken
from another person/ another
species
Indication
For 3 types of cases:
(a) non-union fracture- to promote
union
(b) arthrodesis of joints- to achieve
fusion between joint surface
(c) filling of bone defects/ cavities in
a bone
Types
3 types of bone grafting:
(a) autograft- from same person
(b) allograft- from another person of
same species
(c) xenograft- from different species
Autogenous grafting
Gold standard bone grafting technique
Human has lots of spare bone for such
use
Iliac crest is the commonest site
When graft is needed for osteogenic
purposes, cancellous bone grafts are
preferred
Its available from iliac crests & upper
end of tibia
When graft is used for providing
stability, (filling bone gaps), cortical
grafts are used (site:fibula)
Grafts described are free grafts
Primarily provides a scaffolding upon
which new bone is laid down
Bone stimulating protein/ BMP (bone
morphogenic protein) is liberated from
bone grafts
This helps in osteogenesis
Over a period of time, bone grafts are
replaced by new living bone
Newer techniques of autogenous bone-
grafting are such that while graft is being
placed on its receptor area, its blood
supply is maintained
2 ways of doing it:
(a) muscle pedicle bone grafting
(b) free vascularized grafting

Muscle pedicle bone grafting
Bone graft is taken along with a
pedicle of muscle
The muscle (with its intact blood
supply) continues to supply blood to
the graft
Commonly done for treating non-
union of fracture of neck of femur
(Baksi)
Free vascularized grafting
Bone (usually the fibula) is taken
along with vessels supplying it
It is placed at new site, & its vessels
anastomosed to a nearby vascular
bundle
Such a graft, therefore, remains as
it is & gets incorporated with the
parent bone
Microsurgical techniques are required
for free vascularized grafting
Allogenous grafting
Needed when not enough bone
available from the host (e.g. big defect
following a tumor resection)
Bone graft obtained from another
human being, live/ dead
The latter is called cadaveric graft
Allogenous graft from mother often
used when childs bone reserves are
not enough to fill a big gap
Another method of using allograft is by
preservation of bone from another
person
Allogenous grafting
Bone removed from a patient may be
preserved by deep freezing (at -
70degrees Celcius), by decalci-fying it/
by formalin preservation
Such a bone can be used for another
patient at a later date after due
processing
Hospitals performing tumor excision
surgery in a big way have regular
department procuring bones from
patient & cadavers, processing it &
storing it
These are called bone banks
Xenografting
Bone grafts from another species,
usually bovine
Available in tailor-made sizes
Use is not common yet
Artificial bone
Material derived from corals
Its hydroxyapetite with porous
structure
Its supposed to have
osteoconductive potential & being
used in some countries
Technique
A graft may be used as a solid slab
from a cortical bone (commonly a
segment from the fibula)/ as
cancellous bone slivers/ chips
(commonly from the iliac crest)