Types of Bone Grafts and Substitutes

Intro

Fracture repair undergoes a well-orchestrated biologic progression that involves a multitude of singling pathways that are regulated by certain local and systemic factors. Any aberration from this cascade can impede or halt the healing process. Amongst these complications come delayed unions, nonunions and malunions. Treatment of these firstly depends upon reparation of alignment, stable fixation and complementary techniques such as bone grafting or bone graft substitutes to further encourage bone healing. Worldwide, it is estimated that about 2.2million bone graft procedures are performed each year (1). The indications for their use include: malunions, nonunions, arthrodesis and reconstructive procedures. This paper will explore the various types of bone grafts and substitutes, their properties and the clinical scenarios in which you would use them.

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Properties of Bone grafts

There are three components that allow for the success of bone graft materials in abetting the healing of fractures and formation of new bone: an osteoinductive matrix, which is a scaffold that supports the ingrowth of new bone, blood vessels and perivascular tissue, as well as its attachment of osteoprogenitor cells; osteoinductive proteins, refers to the recruitment and differentiation of pluripotent mesenchymal stem cells into bone forming osteoprogenitor cells- this is mediated by graft derived growth factors such as bone morphogenic protein (BMP). Osteogenesis refers to the process of bone formation after terminal differentiation of osteogenic progenitor cells into mature osteoblasts. These three processes create the signals, scaffolds and cells necessary for the initial phases of fracture healing and one or more of these factors is usually present in bone grafts/substitutes. (2)

Bone grafting stimulates the sequence of events similar to most tissue regeneration and can be seen in Figure 1.

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