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Skeletal Pathobiology > Biology of Fracture Healing > Flashcards

Biology of Fracture Healing Flashcards

1
Q

what makes up the biology of bone healing?

A

location
cellular response
soft tissue envelope

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2
Q

what happens with blood flow after an injury to bone?

A

surviving vasculature becomes enhanced
re-establishment of medullary circulation
extraosseous circulation

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3
Q

what is extraosseous circulation?

A

new, transient blood supply from surrounding soft tissues

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4
Q

what does instability of a fracture with bone fragments favor?

A

resorption of bone

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5
Q

what is secondary bone healing?

A

healing via callus formation

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6
Q

what are the phases of secondary bone healing?

A

injury
inflammatory phase
reparative phase
remodeling phase

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7
Q

what happens in the inflammatory phase of secondary bone healing?

A

hemorrhage at fracture site
resorption of bone ends
formation of granulation tissue

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8
Q

what is the size of the callus proportional to?

A

amount of motion at fracture site

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9
Q

what happens in the remodeling phase of secondary bone healing?

A

slow change of callus and bone
haversian remodeling

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10
Q

what is required for primary bone healing?

A

absolute stability

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11
Q

how much of a gap should there be for primary bone healing?

A

<0.8mm

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12
Q

what is malunion?

A

healed fracture in which anatomic alignment was not achieved

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13
Q

what is nonunion?

A

arrested repair process that requires surgical intervention to create environment conducive to bone healing

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14
Q

what are some things that can cause a delayed union?

A

systemic issues
local post injury response
how the fracture was managed

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15
Q

how can you tell a fracture is delayed union?

A

most long bones will have bone bridging the fracture
healing should look active

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16
Q

what is a delayed union?

A

healing slower than anticipated

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17
Q

is surgical intervention needed for a nonunion?

A

yes

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18
Q

what is a nonunion a result of?

A

often technical failure or decision making
poor biology at the fracture site

19
Q

what does a biologically active nonunion look like?

A

varying amount callus
hypertrophic, slightly hypertrophic, oligotrophic

20
Q

what does a biologically inactive nonunion look like?

A

atrophic, dystrophic, necrotic, defect
biologically inactive: no cells trying to heal

21
Q

what can you use a bone graft to do?

A

increase biology

22
Q

what are the types of bone graft?

A

autogenous: cancellous, cortical
allogenic

23
Q

what are the three properties of an autogenous cancellous bone graft?

A

osteogenic
osteoinductive
osteoconductive

24
Q

when will healing occur in the presence of infection?

A

if it is stable
infection not too bad

25
Q

how do fractures get infected?

A

direct inoculation usually
hematogenous
extension from soft tissue infection

26
Q

why are infections with surgical implants so hard to clear?

A

biofilms form on implant: bacterial glycocalyx

27
Q

what is a glycocalyx?

A

polysaccharide coating

28
Q

why does a glycocalyx matter?

A

helps protect bacteria
prevents identification of antigens
alters antibiotic effectiveness

29
Q

how can you treat a fracture site infection?

A

surgical debridement
exchange or autoclave and place implant
lavage/drainage
stability
culture and sensitivity: tissue and implant
remove implants after healed

30
Q

what is the most important factor in re-establishing vascularity to the bone?

A

extraosseous circulation from surrounding soft tissues

31
Q

what happens in the reparative phase?

A

new blood vessels
fibrous tissue
cartilage
woven bone
callus

32
Q

what happens in haversian remodeling?

A

osteoclastic resorption-cutting cone
osteoblasts deposit osteoid along walls of resorption

33
Q

when does haversian remodeling start in primary bone healing?

A

from the onset

34
Q

what are some things for osteoinduction?

A

decalcified bone matrix
cancellous bone graft

35
Q

what is osteomyelitis?

A

inflammation of bone marrow, cortex, and periosteum

36
Q

what is the most common form of osteomyelitis?

A

chronic post-traumatic

37
Q

what does re-establishment of medullary circulation after an injury do?

A

replaces supply from principal nutrient artery

38
Q

what are the components of primary bone healing?

A

gap <0.8mm
haversian remodeling from onset
must have apposition
requires absolute stability

39
Q

by 8 weeks _______ of new haversian canals traversed fracture site in contact healing

A

60%

40
Q

what are the locations for an autogenous cancellous bone graft?

A

proximal humerus
proximal tibia
wing of ilium

41
Q

what does an allograft provide?

A

osteoconduction
minimal osteoinduction
no viable cells

42
Q

what are the modes of infection?

A

concurrent vascular compromise
soft tissue injury
foreign material
instability
impaired host defense
complication with fracture repair most common

43
Q

why are infections so hard to clear?

A

ischemic areas of tissue
structural blockade
biofilms: bacterial glycocalyx

Skeletal Pathobiology (12 decks)

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