- Discussion:
-
bone graft harvest techniques:
-
allografts:
- bone marrow aspirates:
- in order to maximum the concentration of osteoblast precursors, no more than 2 cc should be aspirated from any single anatomic site;
- unless the surgeon has specific training in bone marrow harvest technique, then it is more likely that the aspiration will yield blood rather than marrow;
- references:
- Aspiration to obtain osteoblast progenitor cells from human bone marrow: The influence of aspiration volume.
GF Muschler MD et al.
JBJS
Vol 79-A.
No 11.
Nov 1997. p 1699.
-
Percutaneous Autologous Bone-Marrow Grafting for Nonunions. Influence of the Number and Concentration of Progenitor Cells.
- bone grafting for
open fractures:
- it is controversial as to whether bone grafting should be performed in open fractures;
- in the study by
Chapman et al (JBJS 1997) 31% of open fractures were treated w/ bone graft substitutes and 28%
of open fractures were treated w/ autogenous bone grafts;
- in this same study, infection at the fracture site occured in 5% of of patients in which bone graft substitutes
were used versus 13% of fractures in which autogenous grafts were used;
-
osteogenic proteins:
-
bone graft substitutes:
- main disadvantage of these substitutues is that they cannot be easily "packed" into the frx or non union site (where as cancellous
allograft chips can be nicely impacted into the bone defect);
- with soft allograft substitutes (such as grafton), once the material fills the defect, it is difficult to stuff in additional graft;
-
demineralized bone matrix:
- hydrochloric acid is the agent of choice for demineralization;
-
grafton:
-
type of demineralized bone matrix from Osteotech, Inc.
-
calcium phosphate:
-
hydroxyapatite
-
pro-osteon and interpore:
- preparation includes heating a species specific coral (calcium carbonate) in an aqueous phosphate solution bath,
the result of which is exchange of the calcium carbonate skeleton to a calcium phosphate skeleton;
- disadvantages include poor osteoinduction, poor absorption, and poor handling (material is not moldable);
- moldable hydroxyapatite;
-
bone source (orthofix):
- made up of two compounds (tetracalcium phosphate and dicalcium dihydrate) which when mixed together with water
causes them to solidify into a hardened cement over 10-15 min;
-
collagraft (zimmer):
- consists of
type I collagen, a biphasic ceramic (hydroxyapatite and tricalcium phosphate), and bone marrow;
- may be used in open fractures;
- ref: Multicenter trial of Collagraft as bone graft substitute. Cornell CN, Lane JM, Chapman M, et al: J Orthop Trauma 5:1-8, 1991
-
calcium sulfate:
- biologically inert osteoconductive material which serves as a temporary scaffold for osteoblasts;
-
osteoset (wright medical technology):
- typically dissolves in one to two months;
A roentgenographic, biomechanical, and histological evaluation of vascularized and non-vascularized segmental fibular canine autografts.
Transfer of vascularized grafts of iliac bone to the extremities.
Biological and physical properties of autogenous vascularized fibular grafts in dogs.
Natural history of autografts and allografts.
Effects of bone graft and electrical stimulation on the strength of healing bony defects in dogs.
Use of cortical cancellous allograft for posterior spinal fusion.
Autogeneic cancellous bone grafting following transtrochanteric hip arthroplasty. An attempt to facilitate union of the greater trochanter.
Autologous marrow injection as a substitute for operative grafting of tibial nonunions.
Autograft versus allograft for benign lesions in children.
Microvascular anastomoses for bone grafts in the treatment of massive defects in bone.
Load-bearing capacity of corticocancellous bone grafts in the spine.
Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects.
Periosteal and perichondral grafting in reconstructive surgery.
Bone Graft Substitutes: Basic Science. Calcium sulfate and calcium phosphate based bone substitutes. Mimicry of the Mineral Phase of Bone
Bobby K. B. Tay MD Vikas V. Patel MD and David S. Bradford MD Orthopedic Clinics of North America.
Volume 30. Number 4. October 1999
