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Bone: grafting

pequis

Introduction

  • Roles:
    • Augmentation of bone repair by gradual replacement by host tissue via a process known as creep substitution.
    • Osteogenesis (new bone formation from graft transferred cells), osteoinduction (signaling new bone formation) and osteoconduction (acts as a scaffold).
    • In the horses the mechanical support role of grafts is very limited.
  • To replace bone lost as a result of:
  • Types:
    • Bone grafts are classified on the basis of their preservation, source and composition.
    • Fresh grafts are implanted quickly after harvesting, usually with minimal modification.
    • Preserved grafts use ultralow temperatures or desiccation to extend the useful life of the graft. The graft may be treated by decellularization and/or deproteinization prior to preservation to reduce antigenicity, plus sterilization by irradiation. Equine bone is rarely stored in bone banks.
    • Autogenous - graft taken from one site and applied to another site within the same animal; superior to other types; abundant sources in the horse. The advantages are that the grafted bone is incorporated directly into the healing bone structure, and there is no risk of disease transmission or immune response.
    • An allograft is removed from one animal and used in another of the same species.
    • Bone grafts may be composed of cancellous or cortical bone either individually or combined.
    • Synthetic bone grafts are composed of biocompatible materials and are designed to have similar functions to natural materials [LINK]. They have some advantages in being more available and consistent in quality, as well as avoiding the need for collection, potential antigenicity, and deterioration during storage.
    • Fresh autogenous cancellous bone grafts are the most commonly used. The occasional use of free cortical and vascularized cortical grafts has been reported.
    • The most common use of autogenous cancellous bone grafts is long bone fracture repair Femur: physeal fracture - repair Ulna: fracture repair Femur: diaphysis - fracture repair Radius: fracture repair, arthrodesis  PIP joint: arthrodesis MCP / MTP joint: arthrodesis, and comminuted phalangeal fractures Proximal phalanx: fracture Middle phalanx: fracture Distal phalanx: fractures. The grafts do not work well in fracture repair unless there is concurrent good fracture management.
  • Sources:

Biology of bone grafts

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Cancellous bone grafts

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Cortical bone grafts

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Vascularized bone grafts

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Other techniques

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Kold S E & Killingbeck J M (1998) The use of autogenous cancellous bone cysts in the distal phalanges, three cases. Equine Vet Educ 10 (6) 307-312.
  • O'Reilly J L et al (1998) Treatment of a chronic comminuted fracture of the fibula in a horse. JAVMA 212 (3), 396-398 PubMed.
  • Cassotis N J et al (1997) Use of full cortical allograph to repair a metatarsal fracture in a foal. JAVMA 211 (9), 1155-1157 PubMed.
  • Honnas C M et al (1995) Use of autogenous cancellous bone grafting in the treatment of septic navicular bursitis and distal sesamoid osteomyelitis in horses. JAVMA 206 (8), 1191-1194 PubMed.
  • Hanie E A et al (1992) Comparions of two grafting methods in a 4.0 mm drill defects in the third metacarpal bone of horses. Equine Vet J 24 (4), 387-390 PubMed.
  • Jackman B R et al (1992) Treatment of a mandibular bone cyst by use of a corticocancellous bone graft in a horse. JAVMA 201 (6), 892-894 PubMed.
  • Henninger R W et al (1991) Lag screw and cancellous bone graft fixation of transverse proximal sesamoid bone fractures in 15 horses. JAVMA 199 (5), 606-612 PubMed.
  • Boero M J et al (1989) Evaluation of the tibia as a source of autogenous cancellous bone in the horse. Vet Surg 18 (4), 322-327 PubMed.
  • Kold SE, Hickman J (1984) Results of treatment of subchondral bone cysts in the medial condyle of the equine femur with an autogenous cancellous bone graft. Equine Vet J 16 (5), 414-418 PubMed.

Other sources of information

  • Markel M A (2019) Bone Grafts and Bone Substitutes. In: Equine Fracture Repair. 2nd edn. Ed: A J Nixon. W B Saunders, USA. 
  • Wei D & Lopez M J (2018) Bone Grafts and Bone Replacements. In: Equine Surgery. 5th edn. Eds: Auer J A & Stick J A. Elsevier Saunders, USA.

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