![]() Was the first to perform allogeneic whole joint transplantation, and he Prevalent in the first two decades of the 20th century, after theĮxperimental work of Ollier and Axhausen. The clinical application of bone allografting became Major deficiencies in long bones (see Chapter 36) and have been effectively used to treat avascular necrosis of the femoral head (see Chapter 125) ( 163). Free, microvascularized fibular grafts are used to replace Increased active participation of the grafted cells in the healing Of a high percentage of cell survival, rapid incorporation, and Rectus femoris for use in the Davis type of hip fusion (see Chapter 106)Īnd the transfer of the posterior portion of the greater trochanter onĪ quadratus muscle pedicle for nonunions of the femoral neck (see Chapter 29) ( 96, 97, 98 and 99).Īlthough technically more difficult, pedicle grafts have the advantages The anterior iliac crest on the muscle attachments of the sartorius and Viability of the graft by maintaining muscle and ligament attachmentsĬarrying blood supply to the bone or, in the case of diaphyseal bone,īy maintaining the nutrient artery. In local muscle-pedicle bone grafts, an attempt is made to preserve the Pedicle grafts may be local ( 139) or moved from a remote site using microvascular surgical techniques (see Chapter 36). Dual onlay grafting is mostly of historic interest. With good fixation of both cortices on either side of the nonunion Although only four screwsĪre illustrated, this type of grafting requires a minimum of six screws Onlay graft to provide good screw fixation. Used, but this is supplemented on the opposite cortex by a cortical Nonunions of the humerus with osteoporotic bone, a compression plate is The bone at the nonunion site is packed with cancellous bone. The space between the two grafts and between the two ends of The use of the classic dual onlay cortical bone graft is almostĮxclusively limited to the treatment of congenital pseudoarthrosis of Last 20 years instead, we would internally fix the nonunion with aĬompression plate, performing an onlay cancellous bone graft. Graft may be used to treat nonunion of the humerus. Unless protected for a prolonged period of time, can lead to pathologicĪ single-onlay cortical bone graft is shown. The tibia is used as a last resort, because aĭonor site of this size creates a large stress riser in the tibia that, If a long, straight graft is needed, theįibula is preferred. Quarters of the thickened portion of the superior border of the iliacĬrest rather than the tibia. For this purpose, it is preferable to use one half or three Through the bone into the bone graft, resulting in a reasonably solidĬonstruct. Nonunion or fracture site can be bridged with a cortical bone graft andĪ plate applied to the opposite cortex. The bone collapses when they are tightened. Even metal washers and nuts are inadequate, because In osteoporotic bone, screws commonly do not achieveĪdequate fixation. Stabilizing the cervical spine, although with modern techniques it is Most common indication for this graft today is bone grafting and The tibia is the mostĬommon source of this graft the split fibula can also be used. Was employed for both osteogenesis and fixation in the treatment of The single-onlay cortical bone graft was used mostĬommonly before the development of good quality internal fixation and Past, they have never met with much success, because of the immunologic Although xenografts have been tried in various forms in the ![]() This is discussed in more detail later in this chapter and in Chapter 20, Chapter 106, Chapter 126, and Chapter 128.įor practical reasons, isografts are almost never used in human This occurs most commonly in tumor surgery, in which preserved or fresh allografts are used ( 49, 66, 72, 78, 88, 89, 100, 101, 111, 112). When structural whole or partial bones, with or without joint articular Or if it is insufficient and must be augmented. Other types ofīone grafts are indicated only if autogenous bone graft is unavailable Most applications, autogenous bone graft is indicated. The correlationīetween the two is shown in Table 9.1. In this text, we use the new terminology. Bone graft terminology has changed, leading to someĬonfusion.
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