When you break a bone, your body will start the healing process. In most cases, your body is able to repair the break on its own. However, sometimes an injury and fracture result in a loss of bone tissue or deficient healing.
What is a Bone Graft?
A bone graft is a surgical procedure involving transplanting of bone tissue to resolve traumatic loss of bone or delayed and absent healing. By transplanting healthy bone tissue, we are able to replace missing bone and support surrounding tissues. A bone graft is also beneficial for growing bone around an implanted device involving bone loss or a fracture. This can provide structural stability in an area affected by bone loss.
Why Bone Grafting is Performed
Transplanting bone tissue is a great option for people experiencing bone loss from trauma to the hand because it encourages regeneration. As the natural bone grows, it will incorporate the grafted material, leaving with an integrated region of new bone. There are many reasons one might need a bone graft:
- Some individuals may need a bone graft if they experienced multiple or complex fractures that do not respond well to initial treatment.
- The bone surrounding the graft will heal together, resulting in healthier tissues with better function.
- A bone graft can also be used to augment bone around surgically implanted devices, such as plates, screws, or joint replacements.
Who is a Candidate for a Bone Graft on the Finger?
A bone graft may be used for patients with complex fractures who did not respond well to initial treatment. Patients in good general health generally experience little or no problems with bone grafts. If you have experienced bone loss due to accidents or injury to the hands and fingers, you may be a good candidate for a bone grafting procedure.
Patients should ask their surgeon if they should stop taking any medicines ahead of time, such as blood thinners and autoimmune disease medications. Smokers are encouraged to stop smoking before the procedure to speed healing and to minimize risk. Optimal results require an expert for a thorough clinical examination to determine the necessity of a bone graft. Diagnostic tests will aid in determining the precise location of the damage in the affected area. These tests include x-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans. To determine if a bone graft is right for you, contact Drs. Drs. Mark and Jason Pruzansky.
Types of Bone Grafts
The bone used in your bone graft may come from your own body or from a donor. This provides a starting point for new, living bone to grow. The type of bone graft needed depends on the type or extent of injury in need of repair.
Bone is typically harvested from the radius and ulna. If the bone graft required is larger or structurally unique, iliac crest may be used.. The two most common types of bone grafts are:
- Allograft. Allografted bone is sourced from deceased donors stored in a bank. Allografts are advantageous because no additional surgery is needed to acquire the bone, avoiding donor site discomfort. They are rigorously prepared to avoid infection and disease transmission. There is little to no risk of rejection, however incorporation is usually slower.
- Autograft. Autografted bone is the patient’s own tissue. Autograft tissue is the safest and faster healing option. However, harvesting autografted material creates a second surgical site. This option is associated with post-operative pain. Sometimes a two stage procedure is indicated in large defects. The Masquelet technique is an option in complex cases.
How Bone Grafting is Performed
During the operation, your surgeon will insert the bone graft into the damaged tissue and remaining healthy bone. As the native bone begins to grow into the graft, it gradually replaces the grafted material. This results in an integrated region of new bone.
Your surgeon will decide which type of bone graft your injury would benefit best from. You will usually be offered regional anesthesia, general anesthesia with iliac crest grafts which will be closely monitored by our expert anesthesiologists. Most patients go home the same day. While every procedure can vary depending on your unique factors, including the nature of the trauma and the precise location of the surgery, patients can expect a surgical discussion about the where and how the graft will be obtained.
The grafted bone will be shaped to fit the affected area. The graft will then be inserted and usually fixed into place with surgical hardware. Sometimes none is used. This hardware may include:
Once your graft is secured, the incision will be closed with stitches. You may be required to wear a cast or splint to support the bone as it heals. In some cases, this may not be necessary.
Recovering from Bone Graft Surgery
The success of your bone graft and your recovery depend on a number of variable factors. These include the size and precise location of the graft, whether you received an autograft or an allograft, and overall patient health and compliance. Immediately after surgery, most patients will experience pain and swelling. It is usually important to keep the hand elevated for the first few days after surgery to reduce swelling and pain. Your surgeon will guide you on mobility during the first few weeks of recovery.
- Reduce physical activity for 2-3 days.
- Avoid lifting, bending, running, and gripping to help minimize swelling.
- Rest and sleep with the affected area elevated.
- Antibiotics will generally be provided to help avoid infection.
Recovery varies from weeks to months. During this time, we advise all patients to refrain from as much activity and stress to the affected area as possible. Rehabilitative exercise will be closely monitored. At the doctor’s discretion cold and heat may be used to manage discomfort. Continuous elevation is vital to reducing pain, swelling and stiffness.
After receiving clearance from a hand surgeon, patients can rest their injured fingers by applying P.R.I.C.E principles:
- Protect: the injured area may be protected with a splint.
- Rest: the injured finger should be allowed to rest.
- Ice: use a cool pack or ice bag judiciously to reduce swelling and pain.
- Compression: prudently wrapping the area with the assistance of a professional may limit the amount of swelling that can occur.
- Elevate: elevating the finger also helps control swelling by using gravity to limit and reduce the amount of fluid that accumulates in the affected area.
Stop Smoking to Aid in Recovery
Smokers are a high-risk group under any circumstances, but particularly so during and after surgery. Bone grafts fail at higher rates for smokers. The success of your bone graft may be hampered if you smoke tobacco products. This is because tobacco and nicotine prevent the bone graft from fusing into the affected area while also raising your risk for infection.
Therefore, it is important to refrain from smoking for as long as possible. To allow healing and promote osseointegration, we strongly recommend not smoking for at least two weeks before and after your bone graft (but we would prefer three months).
If You Believe You Need a Bone Graft for a Finger Injury, Contact HandSport Surgery Institute.
Please contact us as soon as possible to schedule an appointment with our talented team. People who have been injured and are in need of a bone graft should be evaluated to try and prevent further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.