Categories
Procedures

What Is A Bone Graft? | Orthopaedics

Overview of bone graft

Bone grafting is a surgical procedure that uses the transplanted bone to repair and rebuild diseased or damaged bones. A bone graft is a choice for repairing bones almost anywhere in your body. Your surgeon might take bone from your hips, legs, or ribs to perform the graft. Sometimes, surgeons also use bone tissue donated from cadavers to perform bone grafting.

Surgeons often perform bone grafts as part of some other medical procedure. For example, if you have a severe femur fracture, your healthcare provider might perform a bone graft as part of other needed repairs to your bone. Your healthcare provider may make an incision in your hip to remove a small part of your hip bone and use it for the graft. In some cases, artificial material is used similarly, but this is not a bone graft in the traditional sense. You will usually be put to sleep under general anaesthesia for the procedure.

Alternative names for bone graft

  • Autograft – bone
  • Allograft – bone
  • Fracture
  • Autologous

Types of bone grafts

The two most communal types of bone grafts are:

  • Allograft, which uses bone from a departed donor or a cadaver that has been gutted and stored in a tissue bank.
  • Autograft, which comes from a bone within your body, such as your ribs, hips, pelvis, or wrist

The type of graft used to be contingent on the type of injury your surgeon is repairing.

Allografts are usually used in hip, knee, or long bone rebuilding. Long bones include arms and legs. The advantage is that no additional surgery is needed to acquire the bone. It also reduces the risk of infection, as no additional incisions or surgery are required.

Allograft bone transplantation involves bone that does not have living cells, so the risk of rejection is minimal compared to organ transplants, in which there are living cells. Since the transplanted bone does not contain living marrow, it is not necessary to compare the blood types between donor and recipient.

Why might you need a bone graft?

You may need a bone graft to promote bone healing and growth for various medical reasons. Some specific conditions may include:

  • An initial fracture that your healthcare provider suspects will not heal without a graft.
  • A fracture that you had not previously treated with graft and that did not heal well.
  • Bone diseases, such as osteonecrosis or cancer.
  • Spinal fusion surgery (which you may need if you have an unstable spine).
  • Dental implant surgery (which you may need if you want to replace missing teeth).
  • Surgically implanted devices, as in total knee replacement, to help promote bone growth around the frame.

These can provide a framework for the growth of new and living bone. The hips, knees, and spine are common sites for a bone graft, but you may need a bone graft for not the same bone in your body.

The procedure of bone grafts

Typically, a person will be under general anaesthesia during a bone graft procedure. A surgeon will cut and then place the bone substitute in the damaged area. They may use additional tools and supports to hold the graft in place, including:

  • Thumbscrew
  • Wires
  • Cables
  • Dishes
  • Legs

The surgeon will close the wound with stitches. Doctors will monitor a person for several hours after the procedure. Before the person is discharged, they will also give instructions on how to help prevent infection.

Before the bone graft procedure

Tell your surgeon what medications you are taking. This includes medicines, supplements, or herbs that you bought without a prescription. Follow the instructions on how to stop taking blood thinners, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), or NSAIDs such as aspirin. These can cause increased bleeding during surgery.

On the day of surgery

  • Follow the instructions about not eating or drinking anything before surgery.
  • Take the medicines your provider has ordered with a small sip of water.
  • If you go to the hospital from home, make sure you arrive at the scheduled time.

After the procedure

Recovery time rests on the injury or defect being treated and the size of the bone graft. Your recovery can take from 2 weeks to 3 months. It will take up to 3 months or more to heal. You may be told to evade extreme exercise for up to 6 months. Ask your provider or nurse what you can and cannot do safely. It will essential to keep the area clean and dry. Follow the instructions on how to shower.

Smoking slows or prevents bone healing. If you smoke, the graft is more possible to fail. Be aware that nicotine patches delay healing.

Risks factors

Risks of a bone graft procedure include:

  • Nerve injury
  • Infection
  • Bleeding
  • Decreased mobility
  • Cosmetic defects
  • Chronic pain
  • Failure of the graft to achieve its goal
Categories
Disease

Treatment and Types of Bone Fracture | Orthopaedics

What is a bone fracture?

A bone fracture is a medical condition in which the continuation of the bone is broken. A significant percentage of bone fractures occur due to high-energy impact or stress.

However, fractures can also be the result of certain medical conditions that weaken the bones, for example, osteoporosis, some cancers, or osteogenesis imperfecta (also known as brittle bone diseases).

Fractures are common (there are millions in the United States each year) and can be caused by several factors. People can break bones in sports injuries, car accidents, falls, or osteoporosis (weakening of the bones due to aging). Although most fractures are caused by injury, they can still be “pathological” (due to an underlying disease such as cancer or severe osteoporosis). There are more than a million “brittle” fractures each year due to osteoporosis. A broken bone requires immediate medical attention.

Symptoms of bone fracture

The signs and symptoms of a fracture vary depending on the bone effect, the age and general health of the patient, as well as the severity of the injury. However, they often have some of the following:

  • Pain
  • Inflammation
  • Injuries
  • Skin color around the affected area
  • Angulation – the affected area may bend at an unusual angle
  • The patient cannot put weight on the injured area
  • The patient cannot move the affected area
  • The affected bone or joint may have a rubbing sensation
  • If it is an open fracture, there may be bleeding
  • When a large bone like the pelvis or thigh is affected
  • The victim appears pale and flat.
  • May cause dizziness (feeling faint)
  • Feelings of sickness and nausea

If possible, do not move a person with a broken bone while a healthcare professional can assess the condition and, if necessary, place a splint. If the patient is in a dangerous location, such as in the middle of a busy road, action may need to be taken before emergency services arrive.

Types of bone fracture

Fractures generally describe their location, how the bones align, whether there are problems with blood and nerve function and whether the skin at the injury site is intact.

The terms and definitions used in medicine to describe fractures allow healthcare professionals to describe where the fracture is in the bone. For the reference point, the heart is considered central to the body and anatomical descriptions are based on its position as a reference to the heart. When describing a body or body position, stand with your hands slightly apart from your sides, imagine yourself standing and holding your palms forward.

There are some types of fractures, including:

Avulsion Fracture: A muscle or ligament that pulls on a bone and breaks it.

Reported Fracture: The bone is broken into many pieces.

Compression fracture (crush): Usually occurs in the soft bone of the spine. For example, osteoporosis can cause the front of the spine to collapse.

Fracture dislocation: A joint is displaced and one of the bones in the joint is broken.

Greenwood Fracture: The bone is partially fractured on one side, but not completely broken because the rest of the bone is bent. It is more common in children whose bones are softer and more elastic.

Hairline Fracture: A partial fracture of the bone. Sometimes this type of fracture is difficult to detect with routine x-rays.

Affected fracture: When a bone is broken, one part of the bone moves to another.

Intracellular fracture: Where the break extends to the surface of the joint.

Longitudinal fracture: The fracture occurs along the bone.

Inclined fracture: A fracture diagonal to the long axis of the bone.

Symptomatic Fracture: A fracture occurs when an underlying disease or condition has already weakened the bone (bone fracture due to an underlying disease or condition of the weak bone).

Spiral fracture: A fracture that distorts at least part of the bone.

Stress fracture: More common in athletes. Bone fractures due to repeated strains and strains.

Bull fracture: The bone is deformed but does not crack. More common in children. It is painful but constant.

Inverted fracture: Break directly through the bone.

Causes of bone fracture

Most cracks are caused by a bad fall or a car accident. Healthy bones are very hard and tough and can withstand surprisingly powerful impacts. As people age, two factors increase the risk of fracture, weak bones and an increased risk of falls.

Children who have a more physically active lifestyle than adults are also more likely to suffer fractures.

People with underlying diseases and conditions that weaken the bones are at risk for fractures. Examples of osteoporosis, infection, or tumor. As mentioned earlier, this type of fracture is called an asymptomatic fracture.

Frequent stresses and stress breaks as a result of running commonly found in professional athletes are also common causes of fractures.

Risk factors of bone fracture

Anyone can feel the crack. If you have brittle bones or low bone density, you are more likely to develop one. You are more likely to develop brittle bones:

  • Old
  • Have osteoporosis
  • There are endocrine or intestinal disorders.
  • Taking corticosteroids
  • They are physically inactive
  • Drinking alcohol
  • Smoke

Diagnosis of bone fracture

If you suspect you have a fracture, seek medical help immediately. Your doctor will ask about your symptoms and perform a visual exam of the injured area. You may be asked to move this area in some way to look for other signs of pain or injury.

If they think you have a fracture, your doctor will order X-rays. According to the American Academy of Orthopedic Surgeons, X-rays are the most common method for diagnosing fractures. They can create images of your bone and reveal signs of breaks or other damage. X-rays can also help determine the type and location of the fracture.

In some cases, your doctor may also order a magnetic resonance imaging (MRI) or computed tomography (CT or CAT) scan to examine your bones or surrounding tissues.

Treatment for bone fracture

Treatment also focuses on providing the injured bone with the best conditions for optimal healing (stabilization). For the natural healing process to begin, it is necessary to align the ends of the broken bone; This is called fracture reduction.

The patient usually falls asleep under general anesthesia when the reduction of the fracture occurs. Fracture reduction can be done by manipulation, closed reduction (removal of bone fragments), or surgery.

Stabilization: As soon as the bones are aligned, they should be stable while they heal. These may include:

Cast or functional plastic braces: These hold the bone in place until it heals.

Metal plates and screws: Current procedures may use minimally invasive methods.

Intramedullary nails: Internal metal rods placed between long bones. Flexible cables can be used for children.

External fixators: External fixators are made of metal or carbon fiber. They have steel pins that go directly to the bone through the skin. They are a kind of scaffolding outside the body.

Usually, the area of ​​the fractured bone remains stable for 2-8 weeks. The duration depends on the bone affected and if there are any problems, such as a blood supply problem or an infection.

Healing: If the fractured bone is properly aligned and stable, the healing process is usually straightforward.

Osteoporosis (bone cells) absorb old and damaged bone, while hollow bones (other bone cells) are used to create new bone.

The callus is the new bone that forms around the fracture. It forms on both sides of the crack and grows on each side until the crack space is filled. Eventually, the extra bone will soften and the bone will remain as before.

The patient’s age, the affected bone, the type of fracture, and the patient’s general health are factors that affect how quickly the bone heals. If the patient smokes regularly, the healing process will take longer.

Physiotherapy: After the bone has healed, it is necessary to restore muscle strength, as well as mobility in the affected area. If the fracture occurs near the joint, there is a risk of permanent stiffness or arthritis. The person may not bend the joint as well as the front.

Surgery: If there is damage to the skin and soft tissues around the affected bone or joint, plastic surgery may be necessary.

Backward unions and non-unions: Fractures that do not heal nonunion, delayed unions take longer to heal.

Ultrasound treatment: A low-intensity ultrasound is applied daily to the affected area. It was found to heal the fracture. Studies in this area are still ongoing.

Bone graft: If the fracture does not heal, natural or synthetic bone is transplanted to stimulate the broken bone.

Stem cell therapy: Studies are currently underway to determine if stem cells can be used to treat untreated fractures.

Complications of bone fracture

Cure in the wrong condition: This is called a Malonian. The fracture heals in the wrong place or changes (the fracture also changes).

Disruption of bone growth: If a childhood fracture affects the growth plate, there is a risk that the normal development of that bone will be affected, increasing the risk of a subsequent deformity.

Persistent infection of the bones or bone marrow: If the skin is broken, the compound can crack and cause bacteria to enter and infect the bone or bone marrow, which can develop into a chronic infection (chronic osteomyelitis).

Patients must be hospitalized and treated with antibiotics. Sometimes surgical drainage and curettage are required.

Bone death (avascular necrosis): The bone can die if it loses the necessary blood supply.

Prevention of bone fracture

Nutrition and sunlight: The human body needs an adequate supply of calcium for healthy bones. Milk, cheese, yogurt, and dark green leafy vegetables are good sources of calcium.

  • Our body needs vitamin D to absorb calcium; Exposure to sunlight, as well as eating eggs and oily fish are good ways to get vitamin D.
  • Vitamin D plays an important role in maintaining healthy bones.
  • Physical Activity: The more you exercise with the weight, the stronger and denser your bones will be.
  • Some examples are jumping, walking, running, and dancing, any exercise such as the body on the skeleton.
  • Aging is not the only cause of weak bones, often with less physical activity, further increasing the risk of weak bones. People of all ages need to be physically active.

Menopause: Estrogen, which regulates a woman’s calcium, drops during menopause, making calcium regulation much more difficult. Consequently, women need to be especially careful about the density and strength of their bones during and after menopause.

The following steps may help reduce post-menopausal osteoporosis risk:

  • Do several short weight-bearing exercise sessions each week
  • Do not smoke
  • Consume only moderate quantities of alcohol, or don’t drink it
  • Get adequate exposure to daylight

Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, a doctor may recommend calcium supplements.