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Therapeutic and corrective measures
Transplantation of bone is aimed at stimulation of bone formation and giving structural support until a defect has been bridged by new bone. If the bone cells of the transplant survive, they can continue to form bone and can stimulate adjacent tissue to formation of bone. Without survival, the transplant may function as a scaffold for invasion by tissue from adjacent bone, guided by the microstructure of the dead transplant. Cell-rich cancellous bone stimulates bone formation more effectively than does cortical bone, which gives better structural support.
The fundamental problems in transplantation of bone, as with other tissues, are cell death because of deficient blood supply and a tendency toward rejection. The smaller the transplant, the better are the possibilities that blood vessels will reach the cells in time; this is why many small chips are used for stimulation of bone formation. Another possibility is to transplant bone in continuity with attached vessels in order to preserve the blood supply of the transplant. The immunologic problem is usually circumvented by use of bone from the individual himself (autotransplantation). In children sufficient bone for autotransplantation is often not available; bone from another individual will then be used. An attempt to modify the immunologic reaction to such a transplant is usually made by radiation and by storage in a bone bank.
Common indications for transplantation of bone are nonunion of a fracture, a bone cyst, arthrodesis, and structural defects in cancellous bone caused by compression fracture—for example, the heel bone.
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