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    MONO6-2ND

    Chapter 2 | Bone Graft Substitutes: Classifications and Orthopedic Applications

    Published: Nov 2014


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    Abstract

    Although autologous bone graft (ABG) from the iliac crest is considered the standard for grafting, numerous reports have also shown complications and additional morbidities that can add significant medical care and expense. Since the early 1990s, bone graft substitutes have been gaining acceptance as alternatives or extenders to local bone so that ABG does not need to be harvested. Over .5 billion of bone graft substitutes is used annually in the United States as part of orthopedic procedures. Demineralized bone matrix (DBM) was first described by Urist and has been commercially available for over 20 years. However, most commercial formulations of DBM are composed of particles of DBM mixed with a carrier material for better handling characteristics. The osteoconductivity of these formulations leaves much to be desired. Synthetic alternatives using calcium-based scaffolds have been highly engineered to have excellent conductivity but must be mixed with osteogenic signals. Finally, we have seen the rise and fall of the first commericially available recombinant bone morphogenic protein (BMP). Unquestionably, BMP-2 works well; however, significant off-label use has crippled the leading bone graft substitute. This chapter aims to review the bone grafting options from the prospective of where we have been and what the future holds.

    Keywords:

    bone graft, demineralized bone, biosynthetics


    Author Information:

    Abjornson, Celeste
    Weill Cornell Medical College, Hospital for Special Surgery, New York, NY

    Yoon, B. Victor
    Weill Cornell Medical College, Hospital for Special Surgery, New York, NY

    Lane, Joseph M.
    Weill Cornell Medical College, Hospital for Special Surgery, New York, NY


    Committee/Subcommittee: F04.02

    DOI: 10.1520/MONO62013003202