Synthetic bone grafting in foot and ankle surgery

Synthetic bone graft materials have an established role as osteoconductive materials. The basic function is providing a matrix to support the attachment of bone-forming cells for subsequent bone formation, but these materials in various forms can be used for other functions. They can be used as a vehicle for local antibiotic delivery and in injectable form they can be used in a minimally invasive fashion to fill voids and strengthen purchase of screws in osteoporotic bones. They can provide prolonged structural support, which is important for early weight bearing in the lower extremity. These are some of the qualities that may not be obtained from autograft bone, the traditional gold standard for bone grafting. Therefore, these synthetic bone graft substitutes have earned a unique place in the armamentarium when issues such as bone defect, bone quality, and bone infection challenge bone healing and repair. This article reviews the basic science and use of such materials in foot and ankle surgery for conditions related to trauma, tumors, and infection.