BONE GRAFT INCORPORATION

BONE GRAFT INCORPORATION

DNB MS ORTHOPEDICS QUESTION ANSWERS

• successful bone graft eventually gets incorporated into the skeletal system of host
• the graft is enveloped by host bone – replaces the donor bone tissue partially or completely
• rate of incorporation depends on : size – structure – position – fixation – genetic composition
• process of incorporation involves
  • osteoconduction
    • passive phenomenon
    • graft acts as scaffold into which new bone can grow
  • osteoinduction
    • graft matrix with protein inductive factors like BMP – induce adjacent mesenchymal tissues to differentiate into osteoblasts
  • osteogenesis
    • direct formation of new bone by living cells of graft
      
      
      
      
      
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Revascularisation and biological incorporation

• can be
  • direct vascularisation
  • creeping substitution
• never occurs by micro anastomosis with existing microvasculature
  • this occurs only in cancellous bone and aided in cortical bone by removal of periosteum
• creeping substitution
  • most allografts and autografts revascularize only by invasion of capillary sprouts from host bed – during resorption of graft matrix
  • involves invasion of graft by osteoclast – formation of blood vessel bud – new osteons are laid down the many blood vessels that invade the graft

Stages of graft incorporation

• inflammation
• specific immune response
• revascularisation
• osteogenesis
• remodeling

Large grafts incorporation : process of serial stress fracture – resulting in graft remodeling in addition to creeping substitution

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