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:Historical background
Surgeons have gained their experience in
Bone grafts
autografts
allografts
demineralized bone matrix (DBM)
synthetics
bone morphogenetic protein (BMP)
stem cells
Epidemiology
incidence
Indications
assist inhealing of fractures, delayed unions, or
nonunions
assist inarthrodeses and spinal fusions
replace bone defects from trauma or tumor
Properties
Bone graft has aspects of one or more of these
three properties
osteoconductive
osteoinductive
osteogenic
Autograft
Donor sites
iliac crestis the most common site for autograft
autografts
tibial metaphysis
Allograft
Bone graft obtainedfrom a cadaverand
Processing methods
debridement of soft tissue, wash with ethanol (remove live cells), gamma
irradiation (sterilization)
dose-dependent higher doses of irradiation kills bacteria and viruses but may
impair biomechanical properties
fresh
allograft
cleansing and processing removes cells and decreases the immune response
improving incorporation
indications
rarely used due to disease transmission and immune response of recipient
frozen
or freeze-dried
allograft
removes the minerals and leaves the
Properties
osteoconductivewithout structural support
minimally osteoinductive despite preservation
of osteoinductive molecules
interproduct and interlot variability is common
Synthetics
Alternative to autografts and allografts
Various compositions available
Made in powder, pellet, or putty form
Properties
osteoconductive only
Outcomes
Level I evidence shows that calcium-phosphate