2. DEFINITION
 Bone grafting is a surgical
procedure that places new
bone or a replacement
material into spaces
between or around broken
bone (fractures) or in holes
in bone (defects) to aid in
healing.

3. USES
Bone grafting is used to repair bone fractures that
are extremely complex, pose a significant risk to the
patient, or fail to heal properly.
 Used to help fusion between vertebrae, correct
deformities, or provide structural support for
fractures of the spine.
 To repair defects in bone caused by congenital
disorders, traumatic injury, or surgery for bone
cancer.
Bone grafts are also used for facial or cranial
reconstruction

4. MAJOR FUNCTIONS OF GRAFT
MATERIAL
 Osteogenesis, the formation of new bone by the
cells contained within the graft.
 Osteoinduction, a chemical process in which
molecules contained within the graft (bone
morphogenetic proteins, abbreviated as BMP)
converts undifferentiated mesenchymal cells
into cells capable of forming bone.
 Osteoconduction, a physical effect whereby the
graft matrix configures a scaffold on which ,cells
in the recipient form new bone.

5. CLASSIFICATION
Donor origin autograft
allograft xenograft
Composition cortical
cancellous
osteochondral
Preservation fresh frozen freeze dried
demineralized

6. SOURCES OF GRAFT
 Autograft-gold standard bone grafting technique
 A graft made of bone from the patient's own
body is an autograft.
 Usually taken from tibia,fibula or iliac crest to
provide cortical,whole bone transplant and
cancellous bone respectively.
 Iliac crests are the commonest site for takng
bone grafts

7. Disadvantages
 Major disadvantages are limited supply and
donor site morbidity
 Ambulation is delayed until the defect is partially
healed
 pain and infection at the site from which the
graft is taken
 Vascularized grafts - sophisticated microsurgical
techniques are necessary&in major sites of
loading , osseous hypertrophy may occur

8. Allograft
 Allograft is harvested from an individual
other than the one receiving the graft.
 Allografts are used because of the inadequate
amount of available autograft material, and
the limited size and shape of a person's own
bone.
 Usually taken from cadavers; it is typically
sourced from a bone bank.

9. Advantage
 Using allograft tissue from another person
eliminates the need for a second operation to
remove autograft bone or tendon.
 It also reduces the risk of infection, and
safeguards against temporary pain and loss
of function at or near the secondary site.

10. Drawbacks…..
 Bone variability because it is harvested from a
variety of donors.
 Grafted bone may take longer to incorporate
with the host bone and may be less effective
than an autograft.
 Possibility of transferring diseases to the
patient(viral transmissions).
 Potential immune response complications
(patient's immune system fighting against the
grafted bone tissue). This problem is lessened
through the use of anti-rejection drugs.

11.  There are three types of bone allograft
available:
 Fresh or fresh-frozen bone
 Freeze-dried bone allograft (FDBA)
 Demineralized freeze-dried bone allograft
(DFDBA)

12. Xenografts/Heterogeneous
Grafts
 Xenograft bone substitute has its origin from
a species other than human, such as bovine.
Xenografts are usually only distributed as a
calcified matrix.
 Result-unsatisfactory

13. Synthetic variants
Artificial bone can be created from ceramic
such as calcium phosphates (e.g.
hydroxyapatite and tricalcium phosphate),
Bioglass and calcium sulphate; all of which
are biologically active to different degrees
depending on solubility in the physiological
environment.

14.  ]
These materials can be doped with
growth factors, ions such as strontium or
mixed with bone marrow aspirate to increase
biological activity.
 The presence of elements such as strontium
can result in higher bone mineral density and
enhanced osteoblast proliferation in vivo.

15. Alloplastic grafts
 Alloplastic grafts may be made from
hydroxylapatite, a naturally occurring mineral
that is also the main mineral component of
bone. They may be made from bioactive glass
.
 calcium carbonate:unpopular ;completely
resorbable in short time which make the bone
easy to break again

16. Osteoconductive Osteoinductive Osteogenic
Alloplast
+ - -
Xenograft
+ - -
Allograft
+ +/- -
Autograft
+ + +

17. Diagnosis/Preparation
 The surgeon does a clinical examination, and
conducts tests to determine the necessity of
a bone graft,to determine the precise
location of damage,exact amount of damage.
 These tests include x rays,
magnetic resonance imaging (MRI), and
computed tomography (CT) scan.

18. thorough physician consult before surgery
Arrange for blood in case a transfusion is needed
Proper nutrition to achieve good nutritional status
before and after surgery
following a recommended exercise program before
and after surgery.
maintaining a positive attitude
smoking cessation

19. Various techniques
 Single onlay cortical graft: was
mainly used for ununited
diaphyseal fractures , used
for a limited group of fresh,
malunited and ununited fractures.
 Dual onlay grafts: used in treating difficult
and unusual nonunions or for the bridging of
massive defects.

20. Inlay Grafts:
 A slot or rectangular defect is created in the
cortex of the host bone. unpopular:
occasionally used in arthrodesis particularly
at ankle.

21.  4)Peg Grafts
 Used in nonunion of the medial malleolus,
small bones of the hand, wrist or foot.
 5)Medullary Grafts:was used previously for
diaphyseal fractures.
 6)Osteoperiosteal grafts:not used

22.  Multiple Cancellous Chip grafts:
 Particularly used for filling cavities or defects
resulting from cysts, tumors or other causes.
 Also used in arthrodesis of the spine as
osteogenesis is the primary concern
 Hemicylindrical Grafts:
 used for the obliterating large defects of tibia
and femur.A large hemicylindrical cortical graft
from affected bone is placed across the defect
and is supplimented by cancellous iliac bone.

23.  Whole bone Transplant:Greater use is in the
treatment of defects of long bones produced
by massive resection for bone tumors.
 It is the most practical graft for bridging long
defects in diaphyseal portion of bones of
upper extremity.

24. Risks for grafts from the
iliac crest
acquired bowel herniation (this becomes a risk for
larger donor sites (>4 cm)).
meralgia paresthetica (injury to the lateral femoral
cutaneous nerve also called Bernhardt-Roth's
syndrome)
pelvic instability
fracture (extremely rare and usually with other
factors)

25. injury to the cluneal nerves (this will cause
posterior pelvic pain which is worsened by
sitting)
injury to the ilioinguinal nerve
infection
minor hematoma (a common occurrence)
deep hematoma requiring surgical intervention
seroma
ureteral injury

26. pseudoaneurysm of iliac artery (rare)
tumor transplantation
cosmetic defects (chiefly caused by not
preserving the superior pelvic brim)
chronic pain

27. Normal results
 Most bone grafts are successful in helping the
bone defect to heal.
 The extent of recovery depends on the size of
the defect and the condition of the bone
surrounding the graft at the time of surgery.
 Severe defects take some time to heal, and may
require further attention after the initial graft.
 Less severe bone defects heal completely
without serious complications.
 Repeat surgery is sometimes required if the
condition recurs or complications develop.

28.  Thank you……