bone graft

Bone Grafts

Bone Healing

 

Bone healing requires 3 things

- osteoconduction - scaffold / matrix

- osteoinduction - growth factors

- osteogenesis - cells  to produce osteoid

 

Osteoconduction

 

Definition

- property of a matrix that supports the attachment of bone forming cells for subsequent bone formation

 

Substances

Management Bone Defects

AORI / Andersen Orthopedic Research Institute

 

T Tibial  F Femoral

 

1.  Contained Metaphyseal Defect

 

2.  Damaged Metaphyseal

A.  One Condyle

B.  Both Condyles

 

3.  Deficient Metaphysis +/- collaterals +/- extensor mechanism

 

1.  Contained Metaphyseal defect 

 

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Fracture

Epidemiology

 

Young men

 

Aetiology

 

FOOSH

- axial load, dorsiflexion and radial deviation

 

DISI occurs in ulna deviation

 

Herbert Classification

 

Type A    Stable acute fracture

 

A1 Tubercle

Non-Ossifying Fibroma

AKA

 

Non Ossifying Fibroma

 

Definition

 

A hamartomatous defect in the metaphyseal cortex of skeletally-immature adolescents

 

Fibrous cortical defect 

- < 2cm in diameter

 

Non ossifying fibromas 

- > 2cm

 

Non Ossifying Fibroma

 

Aetiology

 

Chondromyxoid Fibroma

Definition

 

Benign neoplasm of cartilaginous origin composed primarily of myxoid cartilage

 

Previously thought to be Chondrosarcoma

 

Epidemiology

 

Very rare tumour

- young adults 10-30

- M:F 2:1

 

Location

 

Common upper tibia

- metaphysis of long bones

- lower limb predilection

 

Clinical

 

Tenderness