Block Graft: Radiographic Bone Loss Common?

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Dr. F asks:

I did a block graft 2 months ago and it appears that there is some radiographic bone loss around the screw. It this a common finding?

Patient has been placed on precautionary antibiotic regimen and no frank infection is visible at this time. Should I just leave the screw where it is for now and follow the progress periodically? Would the block graft be stable enough now for me to remove the screw at this time? Should I place a new screw in the block graft and remove the original screw? What should I do? Thanks.

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3 Responses to “ Block Graft: Radiographic Bone Loss Common? ”

• Perioplastic Surgeon September 24th, 2007

  
  

  Dear Dr. F

  I have done number a block grafts in my career. Resorption of the block is normal. The studys show on average of about 25% resorption. However, in my experience, resorption around the screw isnt a good sign, especially since you are counting on the fixation of the screws for stability. Stability is key for optimal healing of your graft.

  I would not go in and replace the screw or remove the screw, I would leave it alone and try and milk it along for the desired 4 months healing. Placing on antibiotics at this point with no signs of active infection other then some lucency around the screw may be overkill.

  At this point I wouldnt treat the radiograph if you get me.

  I would do aggressive follow up, bring the patient in weekly or biweekly to make sure a infection doesn’t start. You may get lucky you and the graft may be successful. I even seen cases where half the block works and the other half goes bye bye, you may still be able to place the implant and graft any exposed threads.

  Is there any detectable mobility of your block?
  What type of block was it Allograft or Autograft?

  Some times the best treatment is non treatment and watch how things heal.

  Hope thats helpful.

• Dr. G. September 26th, 2007

  
  

  This is not uncommon to see around the screw. Often soft tissue will work down the screw as the bone resorbs around the screw leaving the screw “high” and it may even pop through the tissues. After two months, there should be initial stabilization already, and especially since there should always be at least two screws, then the problematic one could be removed so the tissue can close.

  I’ve done many autogenous block grafts and there is always some resorption. You can try to countersink the screw next time and then the tendency for the screw to be high is minimized even with some resorption.

  I wouldn’t place a new screw but I would remove it if it is showing through the tissues. Unless there are symptoms of infection I wouldn’t use antibiotics at this stage.

  If there is a large radiographic crater or bone loss around only the screw then it would be prudent to remove the screw and leave the other one. If the block is mobile, then at this stage you will lose the graft and will have to start over. At implant placement time, not all may be lost as the bone recovered from the osteotomy may be placed into the defect after the implant placement and then cover with a membrane. Ensure you have a good “water-tight” and released closure.

• Dr ziv mazor September 26th, 2007

  
  

  Dear Dr F
  Resorption around a fixation screw is a common finding in about 20-25% of autogenous block grafting procedure.If the screw is protruding outside you should reconsider your surgical technique and countersink the screw head while placing the block.Have you fixated the block in two points? This is crucial because of micromovement possibility leading to resorption and block failure.If this is not the case leave it for 6 months and cross your fingers…

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