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Bone grafting

ffelis

Synonym(s): bone grafts; cortical bone grafts; corticocancellous bone grafts; autografts; allografts


Introduction

Cancellous autografts

  • The transplantation of patient-derived cancellous bone in order to promote new bone formation by providing live bone cells and growth factors. Little structural support is gained using this type of graft. Cancellous grafts are most commonly obtained from the proximal humerus or wing of the ilium.

Corticocancellous autografts

  • These grafts contain a mixture of cortical and cancellous bone and can be obtained from the lateral surface of the wing of the ilium.

Cortical allografts

  • Stored allograft provides osteoinductive and osteoconductive functions, but lacks any osteogenic potential. It is antigenic, but this is limited by processing methods. Use of allograft may be preferable to reduce anesthesia time, when large amounts of graft are needed, to reduce morbidity and in older cats.

Uses

  • Fracture repair especially:
    • Revision surgeries because of delayed or non-union, or instability.
    • Highly comminuted fractures. 
    • Open fractures.
    • Where infection is present (osteomyelitis Osteomyelitis).
    • Where rapid healing is desired, eg when external fixator implant loosening may occur after some weeks.
    • In older patients with poor healing potential.
  • Arthrodesis procedures.

Advantages

  • Cancellous bone grafts speed healing by the processes of:
    • Osteogenesis (up to 60% of transplanted cells may be viable and will rapidly begin production of new bone).
    • Osteoinduction (osteoprogenitor cells are induced to transform into osteoblasts at the recipient site, which can then produce new bone. This process occurs more slowly then osteogenesis).
    • Osteoconduction (the graft provides a scaffold for local bone invasion).
  • Corticocancellous grafts provide elements of both osteoinduction and osteoconduction.

Disadvantages

  • Donor site morbidity and lameness.
  • Hemorrhage or seroma if inadequate closure.
  • Collecting a graft adds to the surgical time, and requires preparation and surgery at a remote site, with fresh instruments and drapes.
  • Volume of graft available is limited.
  • Iatrogenic fracture at the donor site is a rare complication.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Depends on the procedure which required the bone graft.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dorea H C, McLaughlin R M, Cantwell H D et al (2005) Evaluation of healing in feline femoral defects filled with cancellous autograft, cancellous allograft or bioglass. Vet Comp Orthop Traumatol 18 (3), 157-168 PubMed.
  • Toombs J P, Wallace L J (1985) Evaluation of autogenic and allogeneic cortical chip grafting in a feline tibial nonunion model. Am J Vet Res 46 (2), 519-528 Europe PMC.

Other sources of information

  • Voss K & Montavon P M (2009) Bone grafting. In: Feline Orthopaedic Surgery and Musculoskeletal Disease. Ed Montavon, Voss & Langley-Hobbs. Saunders, Elsevier. pp 147-148
  • Parker R B (1995) Bone grafting in small animal surgery. Waltham Focus 5, 9-14.
  • Millis D L & Martinez S A (1993) Bone Grafts. In: Textbook of Small Animal Surgery. Ed Slatter. Saunders, Elsevier. pp 1875-1891.

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