Bone grafting

Bone grafting is a type of transplantation used to replace missing bone tissue or stimulate the healing of fractures. This surgical procedure is useful for repairing bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly, leading to pseudoarthrosis. While some small or acute fractures can heal without bone grafting, the risk is greater for large fractures, such as compound fractures. Additionally, structural or morcellized bone grafting can be used in joint replacement revision surgery when wide osteolysis is present.

Bone generally has the ability to regenerate completely but requires a very small fracture space or some sort of scaffold to do so. Bone grafts may be autologous (bone harvested from the patient's own body, often from the iliac crest), allograft (cadaveric bone usually obtained from a bone bank), or synthetic (often made of hydroxyapatite or other naturally occurring and biocompatible substances) with similar mechanical properties to bone. Most bone grafts are expected to be resorbed and replaced as the natural bone heals over a few months' time.

The principles involved in successful bone grafts include osteoconduction (guiding the reparative growth of the natural bone), osteoinduction (encouraging undifferentiated cells to become active osteoblasts), and osteogenesis (living bone cells in the graft material contribute to bone remodeling). Osteogenesis only occurs with autograft tissue and allograft cellular bone matrices.

A more recent application of bone grafting is its use as an antibiotic carrier. Infected bone is poorly perfused, making it difficult to achieve an appropriate antibiotic concentration at the site of infection when intravenous administration is used, especially for antibiotics with large molecules such as vancomycin. In such cases, impacted morcellized bone allografts (IBG), impregnated with local antibiotics can achieve much higher concentrations of antibiotics locally than the minimum inhibitory concentration (MIC).