Professional Documents
Culture Documents
Overview
Max. healing; function from tissue/device; complications; cost, preferred materials at hospitals
Indications:
o Scaffold surface of bone chips allow for direct bone deposition (osteoconduction)
o Cells provides cells which grow bone (ie: red marrow, periosteum, matrix) (osteogenesis)
o Signal provides signaling molecules to induce bone formation (osteoinduction)
Advantages:
o Cortical/cancellous ratio
o Graft size
o Ease of procurement
o Callus distraction (to produce new bone)
Iliac crest
o Cortical cancellous bone, adjacent surgical site (not common; more common for vascularized grafts)
o From middle 1/3 (free vascularized donor site)
Prox 1/3 CPN worry about possible entrapment
Distal 1/3 dont want to disrupt syndesmosis
o Can harvest long cortical struts
o Complications: hematoma, pain, infection, damage to peroneal nerve (prox graft), ankle instability (distal graft)
Calcaneus
Disadvantages: potential for infectious agent transfer, sourcing unreliable, inconsistent quality
o Osteogenesis
Bone Marrow
MSCs
o Osteoconduction
HA, Calcium sulfate
Tricalcium PO4
Ceramics
o Osteoinduction
BMPs
Growth factors
Osteoconductive Products
Corraline hydroxyapatite (material that comes from coral)
Healos: Depuy, Carbonated apatite with collagen, sponge-like consistency when saturated (gets into fusion sites)
Osteoinductors
Bone morphogenic proteins (BMP)
o Magellin = Medtronics
o AGF = Interpore-cross
o Secquire = PPAI Medical
o GPS System = Biomet/Cell Factor Tech.
o SYMPHONY = Depuy Ace
o MTF = Cascade
rh-BMP2/ACS (INFUSE)
o Indications
Treatment of acute open tibial shaft fractures in adults
Used after stabilization with IM nail
Need appropriate wound care management
Improves fracture healing and decreases rate of infection
Must be applied within 14 days after initial fracture
o Contraindications
Allergy/Hypersensitivity to RHBMP-2, bovine type I collagen, or other components
Not used in vicinity of a resected/extant tumors
Skeletally immature (<18 y/o)
Pregnancy
Active infection
Allergy to titanium or titanium alloy
o Side effects
constipation, N/V, allergica reaction at surgical site, local and surgical inflammation, altered mental status, altered
sensation, respiratory difficulties, abnormal healing at fracture site
Abnormal labs:
Pancreatic enzyme levels
Liver function
Anemia
Stryker OP 1
o 3.5mg recombinant BMP-7 + 1g bovine collagen
o No history of malignancy
o No pediatrics
o Pregnancy negative
o Effects of maternal antibodies to OP1 are unknown
o Indications
Long bone non-unions
Recalcitrant to other treatments
Where autogenous bone is unavailable
Offlabel use: revisional or reconstructive surgeries
o Contraindications
no hx malignancy, pregnancy; no children
Summary
o Autogenous bone Gold Standard
o Osteoconductors backfill
o Osteoinductors: Ancillary for revisional cases, poor wound base
o Combination materials current trend, can combine materials to mimic autogenous bone