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Bone Bulletin

Abstract

Introduction

Millions of people around the world currently suffer from orthopaedic injuries and illness due to trauma, degenerative diseases, cancer, and infections that require bone grafting techniques to heal. Bone grafting allows a surgeon to replace missing, broken, or infected bone with a substitute that returns the structural integrity of the bone. Bone grafting can rebuild bones but can also help bones with existing defects to heal properly. There are multiple types of bone grafts, and each may be indicated in different scenarios to optimize healing, restore function, and prevent complications depending on the bone in question. The three broad categories of grafts are autografts, allografts, and synthetic bone grafts, which each have their own set of advantages and disadvantages that must be considered when deciding which to use. When choosing a graft, physicians must consider factors like the size of the defect, the patient's overall health, and the requirements of the bone in question. Autografts are the gold standard for small defects requiring high-quality bone regeneration while allografts are often preferred for larger defects as they offer plenty of material but carry a risk of disease transmission.13 Meanwhile, bone graft substitutes in general are used when neither autografts nor allografts are suitable, typically in large and complex fractures.13 Furthermore, there are three key features of the grafts to consider when evaluating their healing potential and appropriate use: osteogenesis, osteoinduction, and osteoconductiveness. The osteogenic function of bone graft reflects its ability to synthesize new bone. Osteoinductive grafts activate mesenchymal and osteoprogenitor cells in the host's own bone tissue to differentiate into osteoblasts and promote the formation of new bone. Osteoconductive grafts provide a structural scaffolding that supports natural bone formation by serving as a bridge upon which osteoblasts can migrate, and into which blood vessels can grow, thereby incorporating the graft tissue into the host’s bone.

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