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The Use of Osteoconductive Bone Graft Substitutes in Orthopaedic Trauma

Dr. Hak is Associate Professor, Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO.

Dr. Hak or the department with which he is affiliated has received research or institutional support from AO International; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Zimmer and AO North America; and serves as a consultant to or is an employee of Medtronic Sofamor Danek.

Reprint requests: Dr. Hak, Denver Health, Department of Orthopaedic Surgery, 777 Bannock Street, MC 0188, Denver, CO 80204.

Several bone graft substitutes are now available for use in augmenting bone healing following trauma. Many of these products are osteoconductive and are indicated for filling bone defects in conjunction with standard methods of internal and external fixation. Osteoconduction refers to a process in which the three-dimensional structure of a substance is conducive for the ongrowth and/or ingrowth of newly formed bone. Currently used bone graft substitutes that primarily offer osteoconductive properties include coralline hydroxyapatite, collagen-based matrices, calcium phosphate, calcium sulfate, and tricalcium phosphate. These products vary considerably in chemical composition, structural strength, and resorption or remodeling rates. Understanding these differences is important in selecting a bone graft substitute with the properties desired for a specific clinical situation. The limited number of clinical studies and lack of direct-comparison studies between these products require the surgeon to fully understand the properties of each product when choosing a bone graft substitute.

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