Brief note on Bone Grafting

Received: 10-Aug-2021 Accepted Date: Aug 20, 2021 ; Published: 01-Sep-2021

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Abstract

Bone grafting is a surgical treatment that substitutes missing bone in order to mend complex bone fractures that offer a substantial health risk to the patient or do not heal adequately. Some mild or acute fractures can be treated without bone grafting, but big fractures, such as compound fractures, have a higher risk.

Bone has the ability to repair entirely, but it does so only with a very small fracture gap or a scaffold. Autologous (bone extracted from the patient’s own body, typically from the iliac crest), allograft (cadaveric bone received from a bone bank), and synthetic (generally constructed of hydroxyapatite or other naturally occurring and biocompatible compounds) bone grafts are available. Over the course of a few months, most bone grafts should be reabsorbed and replaced as the natural bone recovers.

Introduction

In reconstructive orthopaedics, bone is used to fix skeletal abnormalities and speed up bone healing. Bone grafts have a mechanical as well as a biological function. Bone grafting is a surgical treatment that substitutes missing bone in order to mend complex bone fractures that offer a substantial health risk to the patient or do not heal adequately. Some mild or acute fractures can be treated without bone grafting, but big fractures, such as compound fractures, have a higher risk. A bone transplant is a procedure that can be used to mend bones practically anywhere on your body. To accomplish the graft, your surgeon may take bone from your hips, legs, or ribs. Occasionally, surgeons will do bone grafting using cadaveric bone tissue. Bone matrix makes up the majority of the skeleton. This is the hard substance that aids in the strength of the bones. Living bone cells can be found within the matrix. This matrix is created and maintained by these. When necessary, the cells in this matrix can aid in bone repair and healing. The surgeon places a fresh piece of bone in the area where a bone needs to repair or connect during a bone transplant. The cells inside the new bone can then adhere to the old bone and form a seal. Bone grafting is frequently done in conjunction with another medical operation by surgeons. A bone graft may be conducted as part of other necessary bone repairs if a patient has bad thighbone fracture. The surgeon may conduct the graft by making an incision in hip and removing a small portion of hip bone [1]. Bone grafts are utilised as a filler and scaffold to help stimulate wound healing and bone growth. These grafts are biodegradable and do not produce an antigen-antibody reaction. These bone transplants operate as a mineral store, encouraging the development of new bone. Bone grafting is possible because, unlike most other tissues, bone tissue has the potential to regenerate entirely if given enough room to expand. Native bone will usually entirely replace the graft material as it grows, resulting in a fully integrated new bone area. The physiologic mechanisms of osteoconduction, osteoinduction, and osteogenesis give a basis for bone grafting.

Methods of Bone Grafting

Bone has the ability to repair entirely, but it does so only with a very small fracture gap or a scaffold. Autologous (bone extracted from the patient’s own body, typically from the iliac crest), allograft (cadaveric bone received from a bone bank), and synthetic (generally constructed of hydroxyapatite or other naturally occurring and biocompatible compounds) bone grafts are available. Over the course of a few months, most bone grafts should be reabsorbed and replaced as the natural bone recovers.

AUTOGRAFT

In autologous (or autogenous) bone grafting, bone is taken from the same person who will receive the graft. Bone can be harvested from non-essential bones such as the iliac crest, or from the mandibular symphysis (chin area) or anterior mandibular ramus (coronoid process) in oral and maxillofacial surgery; this is especially true for block grafts, in which a small block of bone is placed whole in the area being grafted. When performing a block graft, autogenous bone is the ideal material since it has a lower chance of graft rejection because it comes from the patient’s own body. The advantage of using your own tissue is that it increases the likelihood of a successful fusion, but the amount of bone tissue available is restricted.

DENTIN GRAFT

Dentin bone, which is derived from extracted teeth is a type of bone. Dentin has a chemical composition comparable to bone, with 70-75 percent HA mineral and 20% organic matrix, predominantly fibrous type I collagen. While being resorbed by osteoclasts, dentin, like bone, may release growth and differentiation factors.

ALLOGRAFTS

Allograft bone is derived from people, just like autogenous bone; the difference is that allograft is obtained from someone other than the person receiving the graft. Allograft bone is often received from a bone bank and comes from cadavers who have donated their bone so that it can be utilised for living persons in need. Living human bone donors (typically hospital inpatients) who are undergoing elective total hip arthroplasty are also supplied by bone banks (total hip replacement surgery). As part of the procedure of inserting the artificial hip prosthesis, the orthopaedic surgeon removes the patient’s femoral head during complete hip replacement.

ALLOPLASTIC GRAFTS

Hydroxyapatite, a naturally occurring mineral that is also the major mineral component of bone, can be used to make alloplastic grafts. It’s possible that they’re made of bioactive glass. Because of its osteoconduction, hardness, and acceptability by bone, hydroxylapatite is the most often utilised synthetic bone graft today. Tricalcium phosphate, which is now commonly utilised in conjunction with hydroxylapatite, has both osteoconduction and resorbability effects. Polymers such as microporous PMMA and several other acrylates coated with calcium hydroxide for adhesion are also employed as alloplastic grafts due to their anti-infection properties, mechanical resilience, and biocompatibility [2].

SYNTHETIC BONE GRAFT

This type of graft uses artificially produced materials made from a variety of porous substances. Some also contain proteins that support bone development.

BONE MARROW ASPIRATE

The spongy tissue inside bones is called marrow. It contains stem and progenitor cells, which can aid in the healing of bone fractures. The surgeon extracts a sample of bone marrow from the hip bone with a needle (iliac crest). This bone marrow aspirate is used alone or in combination with other bone transplants to improve allograft bone repair [3].

Treatment

Bone grafts can help in the treatment of fractures, especially if they are not healing properly, bone defects, including: infections, osteonecrosis, which is the loss of blood supply to the bone, trauma, injuries, benign tumors and cysts, birth abnormalities, spinal fusion or other fusions, joint problems.

REFERENCES

1. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-grafting
2. https://en.wikipedia.org/wiki/Bone_grafting
3. https://my.clevelandclinic.org/health/treatments/16796-bone-grafting