![]() These factors must be taken into account when considering the type of graft orsubstitute utilised to augment bone healing. Osteogenicity refers to the provision of osteoprogenitor cells, osteoinductivity to the ability of the graft or substitute to support the proliferation and differentiation of these osteoprogenitor cells, and osteoconductivity to the ability of the substance to facilitate the migration, attachment, and ingrowth of osteoprogenitor cells into the graft ( 10, 11). ![]() Irrespective of the aim, successful healing with bone grafts can be considered using the diamond concept conceptual framework, which states that successful bone healing is dependent on the provision of osteogenic cells, osteoinductive mediators, an osteoconductive matrix, mechanical stability, and adequate vascularity ( 8, 9). Within trauma, there are a number of indications for bone graft, spanning from acute use for traumatic bone defects, as part of staged bone defect management such as that achieved with the masquelet technique, to augment stability and healing in high-risk fractures such as peri-prosthetic femoral fractures, or in improving the biological activity of an atrophic non-union ( 4, 5, 6, 7). Therefore, modern treatment strategies utilise a combination of bone graft and bone substitutes, synthetic materials that can also be inserted into the site of bone loss with or without bone graft to augment healing ( 3). Bone grafting is not, however, without complication, with issues including donor site morbidity and potential immune reactivity when allograft and xenograft are utilised ( 2). Following blood transfusion, bone grafting is the second most commonly performed modality of transplantation, with over two million cases performed annually worldwide ( 2). Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus however, their licencing is limited and larger studies are required to clarify their role.įor recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.īone grafting is a surgical procedure whereby bone tissue is transplanted from one area to another in order to repair or replace non-viable bone or augment the native healing response ( 1). Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft.Īrtificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties. Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth.Īutologous bone graft remains the gold standard, providing all of these qualities. ![]() The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |