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 Fig. 4 Schematic drawing of a vertebral body, on which synthetic bone grafting (vertebroplasty) is performed using the injection-suction method. Two needles are used, one for injecting the synthetic bone material and the other for developing an underpressure in the vertebral body. This method reduces the risk of leakage into vessels or the nerves in the spinal canal.  Fig. 5 Treatment of a wrist fracture with an injectable synthetic bone graft and internal fixation. From Kopylov [4], with permission. |
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The main indications for bone substitutes will be in spinal fusion, bone defects, osteoporotic fractures, revision surgery and, recently, vertebroplasty (injecting a vertebra with synthetic material). Vertebroplasty using polymethylmethacrylate was first introduced in France more than 15 years ago by neurosurgeons, but its use is now spreading rapidly. This mini-invasive procedure for the treatment of vertebral fractures in osteoporosis can reinforce fractured bone, alleviate chronic pain and prevent further vertebral collapse. Vertebroplasty is performed under biplanar fluoroscopic control, CT or guided navigation (fig. 4).
Constantz et al. [3] and Kopylov [4], in his thesis, studied fractures using an injectable bone substitute that sets to a carbonate (fig. 5). In general, the material has been working well, but with some handling difficulties, and histological studies have shown good bone contact.
Outlook
Today, bone grafts are widely used by orthopedic surgeons, plastic surgeons, oral and maxillofacial surgeons, and dentists – next to blood, bone is the second most transplanted tissue.
The use of synthetic bone substitutes is increasing rapidly, and it is hoped that transplantation of bone from donors and animals will one day become obsolete. Careful evaluation of these innovative materials and methods is necessary to determine if they are safe and have the desired healing and mechanical characteristics. But the future holds great promise for the directed regeneration of bone damaged by trauma, disease or degeneration. The rapid advances in biomaterials research and tissue engineering that will continue to take place will supplement and enhance our potential to treat painful and disabling bone conditions.
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