Chapter 1 | Bone Graft Substitutes: Past, Present, and Future

INTRODUCTION The field of medicine as a formal discipline has been traced by many to Imhotep and his descriptions of ailments and treatments found written on papyrus and translated in the mid-1800s by Edwin Smith [1]. Among the medical descriptions included in Imhotep’s writings are cervical dislocations, skull fractures, and compound fractures [1]. Indeed, mummies found in Egyptian tombs have been found with crude braces constructed from wood planks and linen straps on their limbs representing some of the earliest accounts of orthopedics [2]. The use of autografts, allografts, and bone graft substitutes also has interesting origins. The use of each graft type dates back several hundred years to apparently crude yet inspired methods and theories, which nonetheless set the stage for what we today consider state of the art. The following is a brief history of each graft subgroup. Autografts were first used as far back as the early 1800s when, after a trephination (i.e., the practice of drilling holes in the skull to release pressure), Walther repaired the defect by refilling the hole with the original bone plug [3]. This repair resulted in good healing and informally began the practice of autografting. In the late 1800s, more reports of autografting emerged: Seydel used tibial periosteal flaps to close a cranial defect and Bergmann used a fibular graft to close a tibial defect [4]. By the early 1920s, more than 1600 autograft procedures had been documented [4]. However, early structural limitations of cancellous autograft tissue delayed its full emergence, which did not occur until more modern tools of external and internal fixation were available [4]. One of the primary reasons for the success of autografts is their ability to be