Principles of Bone Grafting: Non-union, Delayed Union

Abstract

Autologous bone grafts or autografts (i.e. grafts taken from the patient's own bone) have been used to treat fracture non-unions and occasionally to treat acute fractures. Traditionally, autologous bone is harvested from the iliac crest through a generous, open incision. This can result in significant pain and morbidity. Nowadays, keyhole approaches to this site are often preferred. Alternatively, allografts (grafts from another person) or synthetic bone substitutes may be used. In situations where rapid incorporation is required, autologous graft remains the treatment of choice. Thus, it remains the ‘gold standard’ in patients with: • poor vascularity • a history of infection • failed attempts at non-union repair • fracture site gaps • unfavourable mechanical circumstances. This contribution will review the current indications, contraindications and techniques of bone grafting, and will briefly mention new techniques of grafting and the use of allografts and bone graft substitutes.