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The natural bone repair processes are sufficient to effect timely restoration of skeletal integrity for most fractures when an appropriate mechanical environment exists or is created with internal fixation or coaptation. However, some situations require manipulation or augmentation of natural healing mechanisms to regenerate larger quantities of new bone than would naturally occur to achieve surgical goals. Examples include substantial loss of host bone from trauma, arthrodesis, nonor delayed unions, or insufficient healing potential of the host because of local or systemic disease, e.g. bone infection or osteocyst like lesions. Materials and strategies that are employed must duplicate and amplify the events of secondary bony formation to achieve the desired result. Bone can be regenerated through the following strategies: osteogenesis—the transfer of cells; osteoinduction—the induction of cells to become bone; osteoconduction, providing a scaffold for bone forming cells; or osteopromotion—the promotion of bone healing and regeneration by encouraging the biologic or mechanical environment of the healing or regenerating tissues. The most efficacious strategies use as many of these fundamental components of bone regeneration as possible (Figure 1). Table 1: Definition of functions of bone grafts and synthetic bone replacements. Osteogenic graft A graft that supplies and supports bone forming cells Osteoinductive graft A material that has the capacity to induce bone formation when placed into a site where no bone formation will occur Osteoconductive graft A material that provides a scaffold for mesenchymal cells, osteoclasts and osteoblasts to migrate into and proliferate within Osteopromotive graft A material or physical impetus that results in enhancement of regenerating bone Supportive graft A material that provides additional support to the bone

Tissue particularities and problems related to bone healing and fracture repair