Bone grafting: historical and conceptual review, starting with an old manuscript by Vittorio Putti

Abstract

Vittorio Putti has been recognized as one of the founders of orthopedic science. He wrote a number of original papers on different topics from his vast experience of orthopedics. In a paper on bone grafting dated 1912, Putti demonstrated his modern way of thinking by his ability to study past experiences critically and by his willingness to compare his own experiences with those of other orthopedic surgeons. Putti's paper proposes principles that still apply today, and which can be considered as the basis of the modern science of grafting. The results of his work can be summarized as follows: a) The uniformity of bone graft integration processes, and a marked reduction in integration capacity in heteroplastic grafts. b) The osteogenetic incapability of the graft as opposed to the osteogenetic capability of the periosteum. c) Marked reduction in the biological capability of bone that has been treated with preservatives, boiled, or macerated. d) The importance of the quality of the tissues in which the bone graft is inserted, including the mechanical characteristics of the graft and its fixation. e) The importance of asepsis. f) The importance of functional exercise. These important experiences were achieved without Putti having any knowledge of immunology, vascular surgery, tissue preservation or non decalcified histology techniques.