Single Onlay Cortical Grafts
The term onlay graft was coined by Campbell. The technique involves a bone graft in which the transplanted tissue is laid directly onto the surface of the recipient bone. The technique is more of historical importance. The technique is rarely used now.
Dual Onlay Graft
This was devised by Boyd. Two cortical onlay grafts are placed opposite each other on the host bone across the nonunion and are fixed with the same set of screws; they grip the fragments like a vise. Any intervening space at the bone ends is filled with cancellous chips.
Dual grafts also have been used for other nonunions and rarely done now.
Until relatively inert metals became available, the onlay bone grafts were the simplest and most effective treatment for most ununited diaphyseal fractures.
Inlay Grafts
A slot or rectangular defect is created in the cortex of the host bone and a graft of the same size or slightly smaller is fitted into the defect.The technique is still is occasionally used in arthrodesis.
Peg Grafts
The term peg is used to denote a wooden pin pushed or driven into a surface. Peg grafts are similar are used in cases of small bones like scaphoid or small fragments like lateral condyle or medial malleolus. The peg is inserted into the bone fragments after drilling a hole across the fragments.
Medullary Grafts
When a bone graft is placed in medulla of both fragments across the fracture site, it becomes a medullary graft. Medullary bone grafts have not shown good results.
Medullary grafts are now used in the metatarsals, the metacarpals, and the distal end of the radius.
Osteoperiosteal Grafts
The graft tissue is removed with periosteum intact. Osteoperiosteal grafts are less osteogenic than multiple cancellous grafts and are now rarely used.
Multiple Cancellous Chip Grafts
These are widely used for grafting as
- To fill cavities or defects resulting from cysts, tumors, or other causes
- To create bone blocks
- To create wedge in osteotomies.
- To hasten healing.
- In arthrodesis of the spine
Hemicylindrical Grafts
Hemicylindrical grafts are used when the defects in the bone are large. A massive hemicylindrical cortical graft from the affected bone is placed across the defect and is supplemented by cancellous iliac bone.
This procedure is used in limited surgeries in case of tumor resection.
Whole Bone Transplant
Whole bone transplant is used in bridging long defects in the diaphyseal portion of bones of the upper extremity, unless the nonunion is near a joint. Fibula is a dispensable bone and is most commonly used for whole bone transplant.
Popularity: 2% [?]
Related posts:
I shattered my humerus, and the trauma doctor (Horwitz, University of Utah) Salt Lake City, Utah) put it together with 12 screws, two plates and four rods. We are now waiting to see if the bone heals. Unfortunatley, the humeral head has already died.
Is there anyting that can be done to speed up the year-long healing pricess, and the risk of the bone dying from necrosis?
Pleasd respond,
Wina Sturgeon, journalist and athlete
Dr Arun Pal Singh Reply:
December 4th, 2010 at 1:17 pm
@Wina Sturgeon,
Unfortunately till now there is nothing that can expedite the bone healing or for that matter tissue healing in the body.
Factors are known that cause slow healing and modifiable factors can be addressed if slow healing occur but taking it to supranormal level by any external means is not possible.
It may occur sometimes in the future as we understand the processes better but saying this does not solve your issue.
The bone death or necrosis is mostly determined by the nature of injury.
You seem to have quite severe one.
All the best.
of course i mean:, “Is there anyting that can be done to speed up the year-long healing pricess, and lower the risk of the bone dying from necrosis?
Dr Arun Pal Singh Reply:
December 4th, 2010 at 1:21 pm
@Wina Sturgeon,
I did reply to last query. By severity I meant severity of the initial injury which resulted in shattering of the bone.
Thank you for your response, Dr. Singh. Today I had two of the screws removed by Dr. Horwitz, and am now in much less pain. He is the Trauma Surgeon at the University of Utah ER, and is considered brilliant by his colleagues. I just wondered if there were any studies about bone necrosis currently being conducted internationally by any surgeon. My email is winfishh (at) aol.com.