One complication in some people is the non-union of bones after a fracture. In these cases, they can get help from bone grafting or bone graft solution to improve the condition and fusion of the bones.
There are two techniques in bone grafting: either only bone grafting or bone stabilization is done along with bone grafting. Stabilization will be done using all kinds of screws or standard fixators and will not cause any complications.
The method of bone grafting is that first, a piece of bone is taken from other parts of the body and transferred to a part of the bone that is not fused. The bone that is transplanted helps to stimulate and connect the bones.
Stages of bone grafting
In bone grafting, the bones harvested are transplanted into the damaged part; if it is done by methods other than bone grafting with blood vessels, the bones must be crushed first. Bone fragments are in the form of pieces whose dimensions are a few millimetres. Then these pieces are placed in the space between the bones that are not fused.
Because they are alive, the cells in the non-fused bone section grow on the transplanted bone and absorb that tissue into themselves. After absorption in this part, a new structure is formed, and a bond is established between two unfused bone parts.
In this way, the place of unfused bones is filled, and the new bone becomes a factor in stimulating their fusion.
On the other hand, there is a protein inside the bones that, after the transplant, the new bones will stimulate the original bones to grow. As a result, after growth, the two parts of the bones fuse.
When Is Bone Grafting Done?
The uses of bone grafts are as follows:
- In cases where the bone fracture is partial, its repair process is only possible with bone grafting.
- This procedure must be repeated for a person who has had a bone graft but whose bones have not fused.
- People who are facing various diseases in the bone area or are suffering from cancer.
- Implantation of teeth
Complications of bone grafting
Although bone grafting has many advantages and positive results, in some cases, it can be associated with dangerous complications. Like:
- Bleeding
- cause infection
- blood clotting
- Occurrence of brain damage
- cause pain
- Swelling and inflammation
- Rejection of the grafted bone.
One of the essential points you should remember is that if this surgery is performed by an excellent orthopedic surgeon, the risk of dangerous complications is minimized. Therefore, the expertise and skill of the orthopedic doctor will have a significant impact on the outcome of the surgery.
Care After Bone Grafting
The most important steps you should take after surgery are as follows:
- The recovery period after bone graft surgery varies according to the amount of bone that has been transplanted and the wound that has been created. But it takes a minimum of two weeks and three months to complete the recovery period. In a few cases, the recovery period may last more than three months due to the complex and challenging conditions that the patient experiences. But in a normal situation, the healing process ends in less than three months.
- In the first week, don’t do heavy and stressful activities and rest enough to return to the normal state.
- Prohibition of heavy sports activities for patients until the end of the recovery process
- After bone grafting in the first weeks, the diet should include liquid and soft foods like soups and stews.
- During the treatment period, the use of all tobacco products is prohibited. If you are a smoker or drink alcohol, stop using them until the end of the recovery period because these materials are one of the most critical factors in rejecting transplanted bones.
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Sources of bone procurement for transplantation
For bone grafting, bone material must be obtained from a source. The most important sources of bone for transplant are:
- Autologous bone grafting
The most common way to prepare it, which stimulates fracture healing, is to use the patient’s bones.
In this method, which is called autologous bone graft or autogenous bone graft, areas of the patient’s body that do not cause any particular problems for the patient if the bone is removed are used. The most common of these places is a part of the pelvis called the ilium.
- Bone grafting with blood vessels
In another method called a vascularized bone graft, a large piece of living bone with arteries and veins that go into it to feed the bone is separated from the donor site, and at the recipient site, this bone is first attached to the bones with screws. The unfused area is connected, and its artery and vein are connected to the street and the recipient site.
In this method, because the blood flow of the displaced bone is maintained, the bone remains alive and has high efficiency. Using this method is complex and requires the use of microscopic surgery.
- Allograft bone grafting
If this way is not practical, the bone prepared from the deceased’s body is used. This transplanted bone is called an allograft.
Allograft bones, which can be taken from any part of the deceased’s body, are sterilely prepared after laboratory tests to ensure that the bone does not contain viral contamination such as HIV or HCV and are re-sterilized with chemical methods or gamma rays. It is used in several ways. The two standard methods of using them are:
- The content of bone juice is taken and completely dry and used in place of non-boil.
- It freezes at shallow temperatures without dehydrating it. During use, the bone is first removed from the frozen state, and then it is used in the place of non-union.
- Xenograft bone grafting
Rarely, animal bone has been used, called Xenograft (the main difference between animal bone and human bone is in the type of their proteins, and these bones are used after some methods have removed their proteins).
What are bone graft substitutes?
Bone graft substitutes are artificially made substances. These materials are usually made of hydroxyapatite, which is the main bone-building mineral. The physical structure of these materials is made like natural bone in a three-dimensional, spongy, and porous form.
The advantage of this method is that no bone is removed from the person’s own body, and thus the length of the surgery is reduced, bleeding during surgery that occurs when the bone is taken from the donor site does not occur, surgical complications in the donor site such as surgical wound infection do not occur. Of course, the success of this method in welding the non-welded area is less than the methods of using bone.
Other substances that can be used to stimulate fusion are proteins called Bone morphogenic proteins, which can be injected into the non-fusion site to stimulate the local cells to form bone.
