Evolution of Technology

Bone Grafting

Nearly 1 million procedures are performed with the use of bone graft in the United States and continues to grow at a rate of approximately 13% per year. Bone grafts are commonly used in cases for fractures or when there are issues with bone union (healing). Grafts are also commonly used with implants for spinal fusions, joint arthrodesis, as well as trauma or tumor cases. When possible, autografts (graft from another body site in the same patient) are preferred as this decreases the chance of rejection, however this is not always an option due to multiple factors.

Evolution of Procedure

Open Reduction Internal Fixation

When indicated, the goal of surgical treatment for fractures is to decrease pain, restore anatomic relationships, allow early range of motion, and early weight bearing of the affected extremity. Many techniques and implants have been established over time to create stable construct to allow adequate fracture healing. In the setting, that an injury has significant bone loss or has developed into a failed union (improper healing) bone substitutes/graft have been developed to assist in proper healing. There are multiple options for bone grafts such as demineralized bone matrix (DBM), bone morphogenic protein (BMP), stem cells, and much more. Each graft type has unique properties and different mechanisms that lead to boney healing.

Evolution of Diagnosis

Fractures

Fractures occur in all individuals regardless of age. Those who are older and have less dense bone (osteoporosis) are more likely to suffer from a fracture. In youngers patients, fractures are more likely to occur from high energy trauma. Depending on the injury pattern some fractures will require surgery. The techniques to fix and stabilize a fracture vary based on the location and the fracture pattern. Higher energy fractures have the possibility of being irreparable and can be associated with a significant amount of bone loss. The goal of fracture surgery is to establish anatomic relationship of the bone involved to allow early range of motion and weightbearing. However, without adequate bone viability a stable fixation wound not be achievable. Due to technologic advancements bone graft were developed to assist in healing when there are bone voids prevent a stable fixation.