• Bone Graft

    Definition

    During a bone graft, a donated piece of bone is added to the site of a fracture or other bone defect. The new bone can spur bone growth, bridge a gap in a bone, provide support, and aid in healing. The new bone may come from another part of your body (autograft) or from another person (allograft). Rarely, synthetic grafts, which are not bone, are also used.
    Iliac Crest Graft Harvest
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    Reasons for Procedure

    The doctor may recommend a bone graft to:
    • Treat a fracture that is not healing
    • Reconstruct a shattered bone
    • Fill gaps in bone caused by cysts or tumors
    • Fuse bones on either side of a joint
    • Stimulate bone growth to help anchor an artificial joint or other implant

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a bone graft, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Blood clots
    • Nerve damage
    • Rejection of a graft from another person
    • Fat particles dislodge from the bone marrow and travel to the lung (this is rare)
    • Anesthesia reaction
    Factors that may increase the risk of complications include:
    • Long-term medical conditions
    • Advanced age
    • Smoking

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • X-rays of the bone involved
    Leading up to your procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    • Review with your doctor any herbs or supplements that you take. You may be asked to stop taking some.
    • Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
    • Arrange for help at home after returning from the hospital.

    Anesthesia

    Depending on the procedure, you may receive:

    Description of the Procedure

    The method of treatment depends on the type and location of the bone injury or defect and the type of graft you will be receiving.
    Most bone graft procedures use your own bone. The bone is often taken from the iliac crest. This is the bone at your hip, about where you would wear a belt. An incision is made over the part of the bone that will be removed. A special bone chisel will remove the piece of bone. This incision is then closed.
    The doctor will cut through the skin covering the area in need of repair. Any scar or dead tissue will be removed from the area. Your bone will then be reconstructed with the graft. The doctor may need to immobilize the bone. Plates and screws may be used during the procedure to immobilize the bone. A cast or brace may be needed after the procedure.

    After Procedure

    An x-ray may be taken to make sure the bone is in the correct position.

    How Long Will It Take?

    The length of your surgery will depend on the repair needed.

    How Much Will It Hurt?

    Anesthesia prevents pain during the procedure. Pain medicine will relieve discomfort during your recovery.

    Average Hospital Stay

    Your stay in the hospital will depend on the extent of surgery and your progress.

    Post-procedure Care

    Care depends on the procedure and location of the bone graft:
    • Follow your doctor’s instructions for changing the dressing and showering.
    • Do not smoke. Smoking can delay bone healing.
    • Some grafts can fail. You doctor will track progress with x-rays.
    • Be sure to follow your doctor’s instructions .

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
    • Cough, shortness of breath, or chest pain
    • Numbness or tingling at affected site
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopedic Surgeons http://www.aaos.org/

    The Cleveland Clinic http://www.clevelandclinic.org/

    University of Maryland Spine Center http://www.umm.edu/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Bone grafting. The Cleveland Clinic website. Available at http://cms.clevelandclinic.org/ortho/body.cfm?id=77 . Accessed September 8, 2005.

    Canale ST. Campbell's Operative Orthopaedics . 10th ed. St. Louis, MO: Mosby, Inc.; 2003.

    A patient's guide to understanding bone graft. University of Maryland Spine Center website. Available at: http://www.umm.edu/spinecenter/education/understanding%5Fbone%5Fgraft.html . Accessed September 8, 2005.

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