Current concepts of bone grafting in trauma surgery

Abstract

Bone graft in trauma surgery is commonly used in managing bone defects, non-union, fracture related infections, arthrodesis or to provide structural support in fractures. A variety of bone grafts are made available to the treating physician, which includes autograft, allograft and bone graft substitutes. The future of bone grafting in trauma surgery is exciting with the incorporation of technological advancement such as gene therapy, 3D-printing and tissue engineering. Regardless, there are still limitations to what we understand regarding current bone grafting techniques with conflicting literature on their clinical utility and indication. The aim of this review article therefore is to take a step back and critically evaluate the current concepts of bone grafting in trauma surgery, with special emphasis made on reviewing the types of bone graft, biology of bone graft incorporation and indication for its use in various clinical scenarios.

Keywords: Allograft; Autograft; Bone graft; Bone graft substitutes; Trauma surgery.

Fig. 1

Management of tibial shaft non-union using iliac crest bone graft, demonstrating consolidation at 1 year post-operatively.

Fig. 2

Cancellous autograft harvested from the left femur using the Reamer-Irrigator-Aspirator system.

Fig. 3

Vascularized fibula autograft harvested from the contralateral leg to manage tibial bone loss in a patient presenting with open fracture of the right tibia initially managed with debridement, external fixation and cement spacer.

Fig. 4a

Patient presenting with an extra-articular, comminuted, proximal humerus fracture.

Fig. 4b

Patient undergoing surgical fixation of right proximal humerus fracture with a locking plate construct supplemented with a fibular cortical strut graft aiding with reduction of varus deformity.

Fig. 5

Patient presenting with a right periprosthetic femoral fracture with previous cemented unipolar hemiarthroplasty, treated with surgical fixation using a locking plate construct supplemented with strut allograft.

Fig. 6

Use of an injectable calcium sulfate cement to fill metaphyseal bone defect in a depressed lateral tibial plateau fracture.

Fig. 7

Use of the Masquelet technique in the management of tibial bone defect.

Fig. 8a

Non-union of a left subtrochanteric fracture previously managed with an intra-medullary nail.

Fig. 8b

Successful union after treatment with bone graft obtained using the Reamer-Irrigator-Aspirator system and supplemental plating.

Fig. 9

Successful treatment of a previous open right femoral shaft fracture with distraction osteogenesis technique over a cephalomedullary nail.