Bone transplantation in orthopaedic surgery

Abstract

Osteons are the basic units of bone tissue. Four types of bone cells are responsible for building the bone matrix, maintaining it and remodeling the bone. Those are osteoprogenitor cells, osteoblasts, osteocytes, and osteoclasts. The main role of the bone is in the construction of the skeleton that provides support and enables the maintenance of a constant body shape and movement, which is achieved by a complex system of levers influenced by muscle forces at the attachment points. A fracture leads to the process of inflammation, healing and, remodeling that can restore the injured bone to its original state. Nowadays, we are more and more often faced with defects of different size and etiology, which increase the need for bone transplantation. This procedure involves a surgical technique that places a new bone or a suitable substitute between or around the fractured fragments or in the area of the defect to promote bone healing. Bone transplantation is possible because bone tissue, unlike most other tissues, has the ability to fully regenerate if it is provided with adequate conditions and the space in which it will grow. The basic biological mechanisms that justify and explain the principle and utilization of bone grafting are osteoconduction, osteoinduction, and osteogenesis, but the idea of osteopromotion is also worth mentioning. Autografts represent the "gold standard", but due to an increased need allografts from bone banks are primarily used nowadays, while the development of synthetic replacements is the primary research interest, especially the development of the form which could be applied with the use of minimally invasive techniques.