Bone Grafting

What is Bone Grafting

Bone grafting is a surgical procedure to repair damaged bones or joints with another piece of bone or a man-made substitute (bone graft). There are three basic types of bone grafts. You may have a graft from:

  • Your own bone (autograft). A bone graft is often taken from your hip, rib, or leg.
  • A healthy donor (allograft). These grafts are frozen and stored for future use at a tissue bank.
  • A man-made substance similar to bone. These types of grafts do not stimulate new bone growth. They serve as a bridge that new bone can grow into (osteoconduction).

You may need a bone graft if your bone broke into many pieces (complex fracture) and is difficult to treat. A bone graft may also be used to fuse two bones together. This is often done in spinal surgery. Bone grafting may also be part of treatment for cancer or for severe injuries that require reconstruction of the head and face.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood or bone disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Any recent infections you have had, including skin infections.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Delayed healing.
  • Graft failure, requiring additional surgery.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

General instructions

  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home after the procedure.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • If you are having an autograft:
    • An incision will be made over the autograft site. Bone tissue will be removed.
    • The incision will be closed with stitches (sutures) or staples.
  • Your surgeon will make an incision to open up the area over the bone where the graft will be attached.
  • The bone graft will be placed around the bone. It may be held in place with pins, plates, or screws.
  • Your surgeon will close the incision with sutures or staples.
  • A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You will be given pain medicine as needed.
  • You may be sent home with a cast, splint, or brace.
  • Your IV tube will be removed, and the insertion site will be checked for bleeding.
  • Do notdrive for 24 hours if you were given a sedative.

Bone Grafting, Adult, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain.
  • Bruising.
  • Swelling.
  • Stiffness.

Follow these instructions at home:

If you have a splint or brace:

  • Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your fingers or toes tingle, become numb, or turn cold and blue.
  • Do notlet your splint or brace get wet if it is not waterproof.
  • Keep the splint or brace clean.

If you have a cast:

  • Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
  • Do notlet your cast get wet if it is not waterproof.
  • Keep the cast clean.

Bathing

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your cast or splint is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Watch for:

  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area:
    • If you have a removable splint or brace, remove it as told by your health care provider
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag or between your cast and the bag.
    • Leave the ice on for 20 minutes, 2–3 times per day.
  • Move your fingers or toes often to avoid stiffness and to lessen swelling.

Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

  • Do notdrive or use heavy machinery while taking prescription pain medicine.
  • Do notdrive for 24 hours if you were given a medicine to help you relax (sedative).
  • Ask your health care provider when it is safe to drive if you have a cast or splint on your arm, hand, foot, or leg.

General instructions

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have chills or a fever.
  • Your pain medicine is not helping.
  • You have more redness, swelling, or pain around the incision.
  • You have more fluid or blood coming from the incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from the incision.
  • Your cast, splint, or brace:
    • Is too loose or too tight.
    • Gets damaged.

Get help right away if:

  • You have pain or swelling that gets worse.
  • The back of your lower leg (calf) gets red, warm, painful, or swollen.
  • You have chest pain.
  • You have trouble breathing.
  • You have numbness or tingling.
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