Wednesday, September 14, 2011

Bone Grafting in Foot and Ankle Surgery


The use of bone grafts in foot and ankle surgery is a topic of interest to the podiatric surgeon.  Bone grafting may be used in various procedures to replace a defect in the bone, to extend or lengthen a certain bone in the foot, to aid in the fusion of two bones, or in other instances where extra material is needed.  A comprehensive understanding of the biologic principles of bone healing and bone grafting is necessary for the use of these materials.  Some of the information involved in bone grafting may be passed along to the patient as well.

In order for a bone graft to be useful in the body, it must possess certain properties.  These properties are osteoconduction, osteoinduction, and osteogenesis.  Osteogenesis refers to the formation of new bone.  This can only take place in a transplanted piece of bone that is used as a graft when the osteoblasts, or the cells responsible for laying down new bone, are transplanted with the graft and are kept alive.  This is really only possible in a bone graft that comes from the same person that it is being used in, such as a bone graft harvested from the iliac crest that is transplanted into the foot. 

Osteoconduction refers to the ability of a bone graft to allow as a matrix for new bone to grow into.  Once a bone graft is placed into the body, it must be resorbed and incorporated into the body.  A highly osteoconductive material would allow the cells responsible for new bone formation and vascular tissues to easily maneuver into the bone graft. 

Osteoinduction refers to the process by which new bone growth is stimulated in the host’s body.  This occurs when the host’s stem cells are activated and brought to the site of the bone graft, and differentiate into bone cells.  This process is induced by bone morphogenic proteins (BMPs), platelet derived growth factors, and an array of other chemicals, or cytokines, that attract cells to the area. 

Depending on the type of bone graft used, there is generally a mixture of osteoinductive and osteoconductive properties incorporated into the material.  The only materials that will have osteogenic properties are real bone of the patient. 

The use of cortical bone (the tough, highly consolidated outside of a bone) and cancellous bone (the spongier, highly vascular inside of a bone) is also a consideration in bone grafting.  Generally speaking, cancellous bone offers a structure that is highly osteoconductive and osteoinductive, while the cortical bone offers strength to the bone graft. 

Bone grafts are used with great success in foot and ankle surgery, largely due to the fact that these parameters are all considered by the operative surgeon.  The popularity of synthetic materials used as bone grafts speaks to the successful outcome of their use.



Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. Winter Haven, FL 33881 
Phone: 863-299-4551 
www.FLFootandAnkle.com

2 comments:

  1. How long does it take the site of the harvested bone to heal?

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