Single Onlay Cortical Bone Grafting
The term onlay bone grafting was coined by Campbell. The technique involves a bone grafting 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 Bone Grafting
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 Bone Grafting
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 Bone Grafting
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 Bone Grafting
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 Bone Grafting
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 Bone Grafting
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 Bone Grafting
Hemicylindrical bone grafting is 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 Bone Grafting
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.
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