On the transplantation of bone in the treatment of bone and joint injuries

Abstract

The indications for the transplantation of bone in the treatment of bone and joint injuries are:1) delayed union and non -union in the shaft of a long bone;2) correction of mal -union in the shaft of a long bone when osteotony alone is not enough;3) reconstruction of the shaft of a long bone by bridging a gap;4) closure of gaps in the skull and remodelling of the facial bones;5) arthrodesis of a damaged joint.Two types of bone transplant are used: 1) cortical bone; 2) canoellous bone.The main function of a cortical bone transplant is to provide stable internal fixation thus preserving the form of the part which is being repaired. The advantages and disadvantages of the various types of cortical bone transplant have been discussed. The massive onlay graft or the massive sliding onlay, secured with vitallium screws, are the best methods of internal fixation of bones at present available. When the scheme of treatment of a patient is under consideration a decision to use the intact tibia as the donor of the transplant should be taken only when all other methods are considered impracticable.There is great and widening scope for the use of transplants of canoellous bone. They produce more rapid union than oortioal bone grafts. The intact tibia is not damaged. The method is of particular value in fusion of the spine and in arthrodesis of joints.The combination of a cortical bone transplant with oancellous bone chips is a very effective way of securing union in gap fractures.Cancellous bone chips will promote union in a bone which is immobilised by a vitallium plate. This method will probably be more widely used in future.An internal splint and screws made of an absorbable plastic material used in conjunction with oancellous bone chips would be an ideal method of treating delayed union or non -union of fractures. We may yet see that ideal realised