Bauer and Muschler review the basic science of bone graft materials — autograft, allograft, and synthetic substitutes — explaining how each achieves skeletal incorporation through osteogenesis, osteoconduction, and osteoinduction, and what factors govern long-term remodeling.
When selecting a graft material, match its biologic mechanism to the clinical need: small cancellous defects tolerate allograft well; large structural reconstructions rely on osteoconduction alone and remain largely necrotic, making mechanical stability and load transmission critical; and when osteoinduction is needed (atrophic nonunion, compromised host site), demineralized bone matrix or BMP-based biologics add a stimulus that mineralized allograft cannot provide.
Always flag allograft use in patients who may need future solid organ transplantation — sensitization is real even if clinical graft failure is not.
Bauer and Muschler review the basic science of bone graft materials — autograft, allograft, and synthetic substitutes — explaining how each achieves skeletal incorporation through osteogenesis, osteoconduction, and osteoinduction, and what factors govern long-term remodeling.
When selecting a graft material, match its biologic mechanism to the clinical need: small cancellous defects tolerate allograft well; large structural reconstructions rely on osteoconduction alone and remain largely necrotic, making mechanical stability and load transmission critical; and when osteoinduction is needed (atrophic nonunion, compromised host site), demineralized bone matrix or BMP-based biologics add a stimulus that mineralized allograft cannot provide.
Always flag allograft use in patients who may need future solid organ transplantation — sensitization is real even if clinical graft failure is not.